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| 1 | Role of laparoscopic common bile duct exploration in the management of choledocholithiasis显示文摘Surgical fraternity has not yet arrived at any consensus for adequate treatment of choledocholithiasis. Sequential treatment in the form of pre-operative endoscopic retrograde cholangio-pancreatography followed by laparoscopic cholecystectomy(LC) is considered as optimal treatment till date. With refinements in technique and expertise in field of minimal access surgery, many centres in the world have started offering one stage management of choledocholithiasis by LC with laparoscopic common bile duct exploration(LCBDE). Various modalities have been tried for entering into concurrent common bile duct(CBD) [transcystic(TC) vs transcholedochal(TD)], for confirming stone clearance(intraoperative cholangiogram vs choledochoscopy), and for closure of choledochotomy(T-tube vs biliary stent vs primary closure) during LCBDE. Both TC and TD approaches are safe and effective. TD stone extraction is involved with an increased risk of bile leaks and requires more expertise in intra-corporeal suturing and choledochoscopy. Choice depends on number of stones, size of stone, diameter of cystic duct and CBD. This review article was undertaken to evaluate the role of LCBDE for the management of choledocholithiasis. | Nikhil Gupta | 2016 | World Journal of Gastrointestinal Surgery2016，8，5： | 40 |
| 2 | Pathological classification of intrahepatic cholangiocarcinoma based on a new concept显示文摘Intrahepatic cholangiocarcinoma (ICC) arises from the lining epithelium and peribiliary glands of the intrahepatic biliary tree and shows variable cholangiocytic dif-f-e-re-ntiation. To date-,ICC was large-ly classifie-d into adenocarcinoma and rare variants. Herein,we propose to subclassify the former,based on recent progress in the-study of-ICC including the-gross classification and hepatic progenitor/stem cells and on the pathological similarities between biliary and pancreatic neoplasms. That is,ICC is classifiable into the conventional (bile duct) type,the bile ductular type,the intraductal neoplasm type and rare variants. The conventional type is further divided into the small duct type (peripheral type) and large bile duct type (perihilar type). The former is a tubular or micropapillary adenocarcinoma while the latter involves the intrahepatic large bile duct. Bile ductular type resembles proliferated bile ductules and shows a replacing growth of the hepatic parenchyma.Hepatic progenitor cell or stem cell phenotypes such as neural cell adhesion molecule expression are frequently expressed in the bile ductular type. Intraductal type includes papillary and tubular neoplasms of the bile duct (IPNBs and ITNBs) and a superficial spreading type. IPNB and ITNB show a spectrum from a preneoplastic borderline lesion to carcinoma and may have pancreatic counterparts. At invasive sites,IPNB is associated with the conventional bile duct ICC and mucinous carcinoma. Biliary mucinous cystic neoplasm with ovarian-like stroma in its wall is different from IPNB,particularly IPNB showing cystic dilatation of the affected ducts. Rare variants of ICC include squamous/adenosquamous cell carcinoma,mucinous/signet ring cell carcinoma,clear cell type,undifferentiated type,neuroendocrine carcinoma and so on. This classification of-ICC may ope-n up a ne-w fie-ld of-re-se-arch of-ICC and contribute-to the-clini cal approach to ICC. | Yasuni Nakanuma Yasunori Sato Kenichi Harada Mokoto Sasaski Hiroko Ikeda | 2010 | World Journal of Hepatology2010，2，12： | 34 |
| 3 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 4 | Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: An anatomic view显示文摘Large bile duct stone(> 10 mm) or multiple stones(≥ 3) are challenging for endoscopists. Endoscopic sphincterotomy(EST) is a routine therapeutic endoscopic retrograde cholangiopancreatography(ERCP) procedure usually used. It is safe and effective, but severe perforation or massive bleeding are the main causes of mortality. Because of the permanent destroy ofOddi sphincter, the use of EST is still controversial. Endoscopic papillary balloon dilation(EPBD) gives another way to open the sphincter. Less incidence of bleeding, perforation and partly preserving the Oddi sphincter's function are the main advantages. But high incidence of post-ERCP pancreatitis becomes a predominant problem. According to the anatomical feature of Oddi sphincter, limited EST + EPBD seems a more reasonable procedure. Compared to the former two procedures, it makes the stone extraction process much easier with lower incidences of short-term and long-term complications. | Jun Ding Fu Li Hong-Yi Zhu Xi-Wen Zhang | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，3： | 29 |
| 5 | Modern approach to cholecysto-choledocholithiasis显示文摘Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique(including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another. | Lapo Bencini Cinzia Tommasi Roberto Manetti Marco Farsi | 2014 | World Journal of Gastrointestinal Endoscopy2014，6，2： | 28 |
| 6 | Meta-analysis comparison of endoscopic papillary balloon dilatation and endoscopic sphincteropapillotomy显示文摘AIM: To assess endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy (EST) for common bile duct (CBD) stone removal using a meta-analysis. METHODS: Randomized controlled trials published from 1990 to 2012 comparing EPBD with EST for CBD stone removal were evaluated. This meta-analysis was performed to estimate short-term and long-term com-plications of these two treatments. The fixed random effect model or random effect model was established to analysis the data. Results were obtained by analyz-ing the relative risk, odds ratio, and 95%CI for a given comparison using RevMan 5.1. Statistical significance was defined asP < 0.05. Risk of bias was evaluated us-ing a funnel plot. RESULTS: Of the 1975 patients analyzed, 980 of them were treated with EPBD and 995 were treated with EST. Of the patient population, patients in the EPBDgroup were younger (OR=-1.16, 95%CI:-1.49 to 0.84, P<0.01). There were no significant differences in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the incidence of duodenal diverticulum, CBD diameter or the total follow-up time between EST and EPBD groups. Com-pared with EST, the total stone clearance in the EPBD group decreased (OR=0.64, 95%CI: 0.42 to 0.96,P=0.03), the use of stone extraction baskets significantly increased (OR=1.91, 95%CI: 1.41 to 2.59, P<0.01), and the incidence of pancreatitis significantly increased (OR=2.79, 95%CI: 1.74 to 4.45, P<0.0001). The incidence of bleeding (OR=0.12, 95%CI: 0.04 to 0.34, P<0.01) and cholecystitis (OR=0.41, 95%CI: 0.20 to 0.84, P=0.02) significantly decreased. The stone re-currence rate also was significantly reduced in EPBD (OR=0.48, 95%CI: 0.26 to 0.90, P=0.02). There were no significant differences between the two groups with the incidence of stone removal at first attempt, hours of operation, total short-term complications and infection, perforation, or acute cholangitis. CONCLUSION: Although the incidence of pancreatitis was higher, the overall stone clearance rate and risk of bleeding was lower with EPBD compared to EST. | Hong-Chuan Zhao Liang He Da-Chen Zhou Xiao-Ping Geng Fa-Ming Pan | 2013 | World Journal of Gastroenterology2013，19，24： | 27 |
| 7 | Surgical strategy for bile duct cancer:Advances and current limitations显示文摘The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer.Radical resection with a microscopically negative margin(R0)is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections.Complete resection of the tumor is the surgeon’s ultimate aim,and several advances in the surgical treatment for bile duct cancer have been made within the last two decades.Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer,in terms of both longitudinal and vertical tumor invasion.Many meticulous operative procedures have been established,especially extended hepatectomy for hilar cholangiocarcinoma,to achieve a negative resection margin,which is the only prognostic factor under the control of the surgeon.A complete caudate lobectomy and resection of the inferior part of Couinaud’s segmentⅣcoupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma,and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer.Limited resection for middle bile duct cancer is indicated for only strictly selected cases.Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients,especially jaundiced patients anticipating major hepatectomy.Liver transplantation seems ideal for complete resection of bile duct cancer,but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment.Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence,but no definite regimen has been established to date.Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy. | Nobuhisa Akamatsu Yasuhiko Sugawara Daijo Hashimoto | 2011 | World Journal of Clinical Oncology2011，2，2： | 27 |
| 8 | Endoscopic management of biliary complications after liver transplantation: An evidence-based review显示文摘Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients. | Carlos Macías-Gómez Jean-Marc Dumonceau | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，6： | 25 |
| 9 | Endoscopic diagnosis of extrahepatic bile duct carcinoma:Advances and current limitations显示文摘The accurate diagnosis of extrahepatic bile duct carcinoma is difficult,even now.When ultrasonography(US)shows dilatation of the bile duct,magnetic resonance cholangiopancreatography followed by endoscopic US(EUS)is the next step.When US or EUS shows localized bile duct wall thickening,endoscopic retrograde cholangiopancreatography should be conducted with intraductal US(IDUS)and forceps biopsy.Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity.In patients with papillary type bile duct carcinoma,three biopsies are sufficient.In patients with nodular or infiltrating-type bile duct carcinoma,multiple biopsies are warranted,and IDUS can compensate for the limitations of biopsies.In preoperative staging,the combination of dynamic multidetector low computed tomography(MDCT)and IDUS is useful for evaluating vascular invasion and cancer depth infiltration.However,assessment of lymph nodes metastases is difficult.In resectable cases,assessment of longitudinal cancer spread is important.The combination of IDUS and MDCT is useful for revealing submucosal cancer extension,which is common in hilar cholangiocarcinoma.To estimate the mucosal extenextension,which is common in extrahepatic bile duct carcinoma,the combination of IDUS and cholangioscopy is required.The utility of current peroral cholangioscopy is limited by the maneuverability of the“baby scope”.A new baby scope(10 Fr),called“SpyGlass”has potential,if the image quality can be improved.Since extrahepatic bile duct carcinoma is common in the Far East,many researchers in Japan and Korea contributed these studies,especially,in the evaluation of longitudinal cancer extension. | Kiichi Tamada Jun Ushio Kentaro Sugano | 2011 | World Journal of Clinical Oncology2011，2，5： | 26 |
| 10 | Contrast-enhanced ultrasound in the biliary system:Potential uses and indications显示文摘Conventional ultrasound(US)is the first-line imaging investigation for biliary diseases.However,it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases.The use of contrast-enhanced US(CEUS)has reached the field of bile duct disease in recent years and promising results have been achieved.In this review,the methodology,image interpretation,enhancement pattern,clinical usefulness,and indications for CEUS in the biliary system are summarized.CEUS may be indicated in the biliary system under the following circumstances:(1)Where there is a need to make a characterization of intrahepatic cholangiocarcinoma(ICC);(2)For differentiation diagnosis between ICC and other tumors(i.e.hepatocellular carcinoma or liver metastasis)or infectious diseases;(3)For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma;(4)To detect malignant change in Caroli’s disease;(5)To depict the extent of Klatskin’s tumor with greater clarity;(6)To make a distinction between gallbladder cholesterol polyp,adenoma and polypoid cancer;(7)To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer;(8)For differentiation diagnosis between motionless sludge and gallbladder cancer;(9)For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing;and(10)In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube,US contrast agent can be administered to through the tube detect the site of the tube. | Hui-Xiong Xu | 2009 | World Journal of Radiology2009，1，1： | 26 |
| 11 | Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study显示文摘BACKGROUND Recurrence of primary choledocholithiasis commonly occurs after complete removal of stones by therapeutic endoscopic retrograde cholangiopancreatography(ERCP). The potential causes of the recurrence of choledocholithiasis after ERCP are unclear.AIM To analyze the potential causes of the recurrence of choledocholithiasis after ERCP.METHODS The ERCP database of our medical center for the period between January 2007 and January 2016 was retrospectively reviewed, and information regarding eligible patients who had choledocholithiasis recurrence was collected. A 1:1 case-control study was performed for this investigation. Data including general characteristics of the patients, past medical history, ERCP-related factors,common bile duct(CBD)-related factors, laboratory indicators, and treatment was analyzed by univariate and multivariate logistic regression analysis and KaplanMeier analysisly.RESULTS First recurrence of choledocholithiasis occurred in 477 patients; among these patients, the second and several instance(≥ 3 times) recurrence rates were 19.5%and 44.07%, respectively. The average time to first choledocholithiasis recurrence was 21.65 mo. A total of 477 patients who did not have recurrence were selected as a control group. Multivariate logistic regression analysis showed that age > 65 years(odds ratio [OR] = 1.556; P = 0.018), combined history of choledocholithotomy(OR = 2.458; P < 0.01), endoscopic papillary balloon dilation(OR = 5.679; P = 0.000), endoscopic sphincterotomy(OR = 3.463; P = 0.000), CBD stent implantation(OR = 5.780; P = 0.000), multiple ERCP procedures(≥2; OR =2.75; P = 0.000), stones in the intrahepatic bile duct(OR = 2.308; P = 0.000),periampullary diverticula(OR = 1.627; P < 0.01), choledocholithiasis diameter ≥10 mm(OR = 1.599; P < 0.01), bile duct-duodenal fistula(OR = 2.69; P < 0.05),combined biliary tract infections(OR = 1.057; P < 0.01), and no preoperative antibiotic use(OR = 0.528; P < 0.01) were independent risk factors for the recurrence of choledocholithiasis after ERCP.CONCLUSION Patient age greater than 65 years is an independent risk factor for the development of recurrent choledocholithiasis following ERCP, as is history of biliary surgeries, measures during ERCP, and prevention of postoperative complications. | Feng Deng Mi Zhou Ping-Ping Liu Jun-Bo Hong Guo-Hua Li Xiao-Jiang Zhou You-Xiang Chen | 2019 | World Journal of Clinical Cases2019，7，9： | 26 |
| 12 | Biliary tract injury caused by different relative warm ischemia time in liver transplantation in rats显示文摘BACKGROUND:There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia.A liver autotransplantation model was adopted because it excludes the effects of infection and immunological rejection on bile duct injury.This study was undertaken to assess biliary tract injury caused by relative warm ischemia(secondary warm ischemia time in the biliary tract)and reperfusion. METHODS:One hundred and two rats were randomly divided into 5 groups:groupⅠ(control);groupsⅡtoⅤ, relative warm ischemia times of 0 minute,30 minutes,1 hour and 2 hours.In addition to the levels of serum alkaline phosphatase,and total bilirubin,pathomorphology assessment and TUNEL assay were performed to evaluate biliary tract damage. RESULTS:Under the conditions that there were no significant differences in warm ischemia time,cold perfusion time and anhepatic phase,group comparisons showed statistically significant differences.The least injury occurred in groupⅡ(portal vein and hepatic artery reperfused simultaneously)but the most severe injury occurred in groupⅤ(biliary tract relative warm ischemia time 2 hours). CONCLUSIONS:Relative warm ischemia is one of the factors that result in bile duct injury,and the relationship between relative warm ischemia time the bile injury degree is time-dependent.Simultaneous arterial and portal reperfusion is the best choice to avoid the bile duct injury caused by relative warm ischemia. | Zhao, Hong-Feng Zhang, Guo-Wei Zhou, Jie Lin, Jian-Hua Cui, Zhong-Lin Li, Xiang-Hong | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，3： | 24 |
| 13 | Common bile duct stones on multidetector computed tomography:Attenuation patterns and detectability显示文摘AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography(ERCP) were enrolled and reviewed retrospectively.The attenuation patterns of CBD stones on MDCT were classified as heavily calcified,radiopaque,less radiopaque,or undetectable.The association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol,mixed cholesterol,brown pigment,and black pigment and the factors related to the detectability of CBD stones by MDCT were evaluated.RESULTS:MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% sensitivity.The attenuation patterns of CBD stones on MDCT were heavily calcified 34(26%),radiopaque 31(24%),less radiopaque 46(35%),and undetectable 19(15%).The radiopacity of CBD stones differed significantly according to stone type(P < 0.001).From the receiver operating characteristic curve,stone size was useful for the determination of CBD stone by MDCT(area under curve 0.779,P < 0.001) and appropriate cut-off stone size on MDCT was 5 mm.The factors related to detectability of CBD stones on MDCT were age,stone type,and stone size on multivariate analysis(P < 0.05).CONCLUSION:The radiopacity of CBD stones on MDCT differed according to stone type.Stone type and stone size were related to the detectability by MDCT,and appropriate cut-off stone size was 5 mm. | Chang Whan Kim Jae Hyuck Chang Yeon Soo Lim Tae Ho Kim In Seok Lee Sok Won Han | 2013 | World Journal of Gastroenterology2013，19，11： | 24 |
| 14 | Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones显示文摘Although endoscopic sphincterotomy(EST) is still considered as a gold standard treatment for common bile duct(CBD) stones in western guideline, endoscopic papillary balloon dilation(EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, endoscopic papillary large balloon dilation(EPLBD) can facilitate the removal of large CBD stones.The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence. | Kwok-Hung Lai Hoi-Hung Chan Tzung-Jiun Tsai Jin-Shiung Cheng Ping-I Hsu | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，2： | 24 |
| 15 | Endoscopic extraction of large common bile duct stones:A review article显示文摘Since therapeutic endoscopic retrograde cholangiopancreatography replaced surgery as the first approach in cases of choledocolithiasis,a plethora of endoscopic techniques and devices appeared in order to facilitate rapid,safe and effective bile duct stones extraction.Nowadays,endoscopic sphincterotomy combined with balloon catheters and/or baskets is the routine endoscopic technique for stone extraction in the great majority of patients.Large common bile duct stones are treated conventionally with mechanical lithotripsy,while the most serious complication of the procedure is 'basket and stone impaction' that is predominately resolved surgically.In cases of difficult,impacted,multiple or intrahepatic stones,more sophisticated procedures have been used.Electrohydraulic lithotripsy and laser lithotripsy are performed using conventional mother-baby scope systems,ultra-thin cholangio-scopes,thin endoscopes and ultimately using the novel single use,single operator SpyGlass Direct Visualization System,in order to deliver intracorporeal shock wave energy to fragment the targeted stone,with very good outcomes.Recently,large balloon dilation after endoscopic sphincterotomy confirmed its effectiveness in the extraction of large stones in a plethora of trials.When compared with mechanical lithotripsy or with balloon dilation alone,it proved to be superior.Moreover,dilation is an ideal alternative in cases of altered anatomy where access to the papilla is problematic.Endoscopic sphincterotomy followed by large balloon dilation represents the onset of a new era in large bile duct stone extraction and the management of 'impaction' because it seems that is an effective,inexpensive,less traumatic,safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists.When complete extraction of large stones is unsuccessful,the drainage of the common bile duct is mandatory either for bridging to the final therapy or as a curative therapy for very elderly patients with short life expectancy.Placing of more than one plastic endoprostheses is better while the administration of Ursodiol is ineffective.The great majority of patients with large stones can be treated endoscopically.In cases of unsuccessful stone extraction using balloons,baskets,mechanical lithotripsy,electrohydraulic or laser lithotripsy and large balloon dilation,the patient should be referred for extracorporeal shock wave lithotripsy or a percutaneous approach and finally surgery. | Gerasimos Stefanidis Christos Christodoulou Spilios Manolakopoulos Ram Chuttani | 2012 | World Journal of Gastrointestinal Endoscopy2012，4，5： | 23 |
| 16 | Risk factors and classifications of hilar cholangiocarcinoma显示文摘Cholangiocarcinoma is the second most common primary malignant tumor of the liver.Perihilar cholangiocarcinoma or Klatskin tumor represents more than 50% of all biliary tract cholangiocarcinomas.A wide range of risk factors have been identified among patients with Perihilar cholangiocarcinoma including advanced age,male gender,primary sclerosing cholangitis,choledochal cysts,cholelithiasis,cholecystitis,parasitic infection(Opisthorchis viverrini and Clonorchis sinensis),inflammatory bowel disease,alcoholic cirrhosis,nonalcoholic cirrhosis,chronic pancreatitis and metabolic syndrome.Various classifications have been used to describe the pathologic and radiologic appearance of cholangiocarcinoma.The three systems most commonly used to evaluate Perihilar cholangiocarcinoma are the Bismuth-Corlette(BC) system,the Memorial Sloan-Kettering Cancer Center and the TNM classification.The BC classification provides preoperative assessment of local spread.The Memorial Sloan-Kettering cancer center proposes a staging system according to three factors related to local tumor extent:the location and extent of bile duct involvement,the presence or absence of portal venous invasion,and the presence or absence of hepatic lobar atrophy.The TNM classification,besides the usual descriptors,tumor,node and metastases,provides additional information concerning the possibility for the residual tumor(R) and the histological grade(G).Recently,in 2011,a new consensus classification for the Perihilar cholangiocarcinoma had been published.The consensus was organised by the European Hepato-PancreatoBiliary Association which identified the need for a new staging system for this type of tumors.The classification includes information concerning biliary or vascular(portal or arterial) involvement,lymph node status or metastases,but also other essential aspects related to the surgical risk,such as remnant hepatic volume or the possibility of underlying disease. | Miguel Angel Suarez-Munoz Jose Luis Fernandez-Aguilar Belinda Sanchez-Perez Jose Antonio Perez-Daga Beatriz Garcia-Albiach Ysabel Pulido-Roa Naiara Marin-Camero Julio Santoyo-Santoyo | 2013 | World Journal of Gastrointestinal Oncology2013，5，7： | 23 |
| 17 | Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis显示文摘AIM: To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach. METHODS: From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 ℃, leukocytosis greater than 10 × 10 9 /L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis,complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-operative day 6.RESULTS: The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC group at all intra-operative sampling times, but reached significance only when the gallbladder was removed (OC group = 36.81 ± 6.4 ρg/mLvs LC group = 16.74 ± 4.1 ρg/mL, P < 0.05). One hour after surgery, microbiological analysis of blood cultures detected 7 different bacterial species after laparotomy, and 4 species after laparoscopy (P < 0.05). CONCLUSION: OC increased the incidence of bacteraemia, endotoxaemia and systemic inflammation compared with LC and caused lower transient immunological defense, leading to enhanced sepsis in the patients examined. | Federico Sista Mario Schietroma Giuseppe De Santis Antonella Mattei Emanuela Marina Cecilia Federica Piccione Sergio Leardi Francesco Carlei Gianfranco Amicucci | 2013 | World Journal of Gastrointestinal Surgery2013，5，4： | 23 |
| 18 | Multi-slice three-dimensional spiral CT cholangiography: a new technique for diagnosis of biliary diseases显示文摘Objective: To validate multi-slice three-dimensionalspiral CT cholangiography (3-D CTC) in clinical di-agnosis of biliary diseases.Methods: This study included 146 patients with bili-ary diseases, involving 73 cases of biliary tumor, 87cases of radioparent calculus, 12 cases of post cholan-gio-jejunostomy and one case of congenital choledo-chocyst. The data of thin-slice volumetric CT scanwere sent to the workstation (GE Advantage Win-dows 3. 1). Rational 3-D CTC including maximumintensity projection, minimum intensity projection,surface shaded display, CT virtual endoscopy andray sumption was performed. The diagnostic accura-cy of 3-D CTC was compared with that of conven-tional CT, ultrasonography and endoscopic retro-grade cholangiopancreaticography (ERCP).Results: Different biliary diseases showed distinct ima-ging manifestations on 3-D CTC, As a new techniquefor assessing the status of post cholangio-jejunosto-my, 3-D CTC was superior to conventional CT, ul-trasonography and ERCP in diagnosis of negative bil-iary calculus, extrahepatic cholangiocarcinoma,cancer embolus of the biliary duct, carcinoma of thepancreas head and periampullar carcinoma. It wasalso superior to conventional CT, ultrasonography orequal to ERCP in diagnosis of hilar cholangiocarcino-ma, but inferior to conventional CT and ultrasonog-raphy in diagnosis of gallbladder cancer.Conclusion: 3-D CTC as a non-invasive and sensitivetechnique for the diagnosis of biliary diseases withhigh diagnostic accuracy will greatly increase the de-tection rate of biliary diseases. | Ai-Min Xu Hong-Yan Cheng Wen-Bin Jiang Dong Chen Yu-Chen Jia Meng-Chao Wu the Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China | 2002 | Hepatobiliary & Pancreatic Diseases International2002，1，4： | 22 |
| 19 | Contrast-enhanced ultrasound:The evolving applications显示文摘Contrast-enhanced ultrasound(CEUS)is a major breakthrough for ultrasound imaging in recent years.By using a microbubble contrast agent and contrast-specific imaging software,CEUS is able to depict the microand macro-circulation of the targeted organ,which in turn leads to improved performance in diagnosis.Due to the special dual blood supply system in the liver,CEUS is particularly suitable for liver imaging.It is evident that CEUS facilitates improvement for characterization of focal liver lesions(FLLs),detection of liver malignancy,guidance for interventional procedures,and evaluation of treatment response after local therapies.CEUS has been demonstrated to be equal to contrast-enhanced computed tomography or magnetic resonance imaging for the characterization of FLLs.In addition,the applicability of CEUS has expanded to non-liver structures such as gallbladder,bile duct,pancreas,kidney,spleen,breast,thyroid,and prostate.The usefulness of CEUS in these applications is confirmed by extensive literature production.Novel applications include detecting bleeding sites and hematomas in patients with abdominal trauma,guiding percutaneous injection therapy and therefore achieving the goal of using interventional ultrasonography in managing splenic trauma,assessing the activity of Crohn’s disease,and detecting suspected endoleaks after endovascular abdominal aneurysm repair.Contrast-enhanced intraoperative ultrasound(US)and intracavitary use of CEUS have been developed and clinically studied.The potential use of CEUS involves sentinel lymph node detection,drug or gene delivery,and molecular imaging.In conclusion,the advent of CEUS has greatly enhanced the usefulness of US and even changed the status of US in clinical practice.The application of CEUS in the clinic is continuously evolving and it is expected that its use will be expanded further in the future. | Hui-Xiong Xu | 2009 | World Journal of Radiology2009，1，1： | 23 |
| 20 | 在为困难的 choledocholithiasis 的 sphincterotomy 以后的内视镜的乳突的汽球膨胀: 控制盒子的研究显示文摘 AIM:To evaluate the efficacy and safety of endoscopic sphincterotomy(EST) + endoscopic papillary large balloon dilation(EPLBD)vs isolated EST.METHODS:We conducted a retrospective single center study over two years,from February 2010 to January 2012.Patients with large(≥ 10 mm),single or multiple bile duct stones(BDS),submitted to endoscopic retrograde cholangio-pancreatography(ERCP) were included.Patients in Group A underwent papillary large balloon dilation after limited sphincterotomy(EST+EPLBD),using a through-the-scope balloon catheter gradually inflated to 12-18 mm according to the size of the largest stone and the maximal diameter of the distal bile duct on the cholangiogram.Patients in Group B(control group) underwent isolated sphincterotomy.Stones were removed using a retrieval balloon catheter and/or a dormia basket.When necessary,mechanical lithotripsy was performed.Complete clearance of the bile duct was documented with a balloon catheter cholangiogram at the end of the procedure.In case of residual lithiasis,a double pigtail plastic stent was placed and a second ERCP was planned within 4-6 wk.Some patients were sent for extracorporeal lithotripsy prior to subsequent ERCP.Outcomes of EST+EPLBD(Group A) vs isolated EST(Group B) were compared regarding efficacy(complete stone clearance,number of therapeutic sessions,mechanical and/or extracorporeal lithotripsy,biliary stent placement) and safety(frequency,type and grade of complications).Statistical analysis was performed using χ 2 or Fisher’s exact tests for the analysis of categorical parameters and Student’s t test for continuous variables.A P-value of less than 0.05 was considered statistically significant.RESULTS:One hundred and eleven patients were included,68(61.3%) in Group A and 43(38.7%) in Group B.The mean diameter of the stones was similar in the two groups(16.8 ± 4.4 and 16.0 ± 6.7 in Groups A and B,respectively).Forty-eight(70.6%) patients in Group A and 21(48.8%) in Group B had multiple BDS(P = 0.005).Overall,balloon dilation was performed up to 12 mm in 10(14.7%) patients,13.5 mm in 17(25.0%),15 mm in 33(48.6%),16.5 mm in 2(2.9%) and 18 mm in 6(8.8%) patients,taking into account the diameter of the largest stone and that of the bile duct.Complete stone clearance was achieved in sixty-five(95.6%) patients in Group A vs 30(69.8%) patients in Group B,and was attained within the first therapeutic session in 82.4% of patients in Group A vs 44.2% in Group B(P < 0.001).Patients submitted to EST+EPLBD underwent fewer therapeutic sessions(1.1 ± 0.3 vs 1.8 ± 1.1,P < 0.001),and fewer required mechanical(14.7% vs 37.2%,P = 0.007) or extracorporeal(0 vs 18.6%,P < 0.001) lithotripsy,as well as biliary stenting(17.6% vs 60.5%,P < 0.001).The rate of complications was not significantly different between the two groups.CONCLUSION:EST+EPLBD is a safe and effective technique for treatment of difficult BDS,leading to high rates of complete stone clearance and reducing the need for lithotripsy and biliary stenting. | Bruno Rosa Pedro Moutinho Ribeiro Ana Rebelo António Pinto Correia José Cotter | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，5： | 21 |
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