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| 1 | Gallstones in patients with liver cirrhosis:Incidence,etiology,clinical and therapeutical aspects显示文摘Gallstones occur in about one third of the patients having liver cirrhosis.Pigment gallstones are the most frequent type,while cholesterol stones represent about15%of all stones in cirrhotics.Increased secretion of unconjugated bilirubin,increased hydrolysis of conjugated bilirubin in the bile,reduced secretion of bile acids and phospholipds in bile favor pigment lithogenesis in cirrhotics.Gallbladder hypomotility also contributes to lithogenesis.The most recent data regarding risk factors for gallstones are presented.Gallstone prevalence increases with age,with a ratio male/female higher than in the general population.Chronic alcoholism,viral C cirrhosis,and non-alcoholic fatty liver disease are the underlying liver diseases most often associated with gallstones.Gallstones are often asymptomatic,and discovered incidentally.If asymptomatic,expectant management is recommended,as for asymptomatic gallstones in the general population.However,a closer follow-up of these patients is necessary in order to earlier treat symptoms or complications.For symptomatic stones,laparoscopic cholecystectomy has become the therapy of choice.Child-Pugh class and MELD score are the best predictors of outcome after cholecystectomy.Patients with severe liver disease are at highest surgical risk,therefore gallstone complications should be treated using noninvasive or minimally invasive procedures,until stabilization of the patient condition. | Monica Acalovschi | 2014 | World Journal of Gastroenterology2014，20，23： | 39 |
| 2 | Prevalence of and risk factors for gallstones in Uighur and Han Chinese显示文摘AIM:To perform a single-centre survey of the prevalence of and possible risk factors for gallstones in Uighur and Han Chinese.METHODS:Complete medical data for 9455 patients were collected from the medical centre of our hospital,and the overall prevalence of gallstones as well as the prevalence in different ethnic groups was studied.The risk factors for gallstones in different ethnic groups were identified in a univariate analysis,and variables with statistical significance were analysed by unconditional multiple logistic regression,to primarily explore the similarities and differences in gallstone risk factors between different ethnic groups.RESULTS:The prevalence of gallstones was significantly higher in the Uighur population than in the Hanpopulation(22.87%vs 11.64%,P<0.05).Further analysis of risk factors for gallstones based on the different ethnic areas revealed that age was a risk factor for gallstones in both groups;triglycerides,body-mass index(BMI)and high-density lipoprotein were risk factors for gallstones in the Han population,while total cholesterol(TC),gender and fatty liver were risk factors in the Uighur population.The Uighur patients were older than the Han patients,and had higher BMI,TC,low-density lipoprotein,female rate and fatty liver rate,while the incidence of hypertension was lower than that in the Han patients.CONCLUSION:The prevalence of and risk factors for gallstones differ between the Uighur and Han populations. | Li Zhu Aikebaier Aili Cheng Zhang Aili Saiding Kelimu Abudureyimu Xinjiang Medical University | 2014 | World Journal of Gastroenterology2014，20，40： | 39 |
| 3 | 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 |
| 4 | Therapy of gallstone disease:What it was,what it is,what it will be显示文摘Cholesterol gallstone disease is a common clinical condition influenced by genetic factors,increasing age,female gender,and metabolic factors.Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones,new perspectives regarding medical therapy of cholelithiasis are currently under discussion,also taking into account the pathogenesis of gallstones,the natural history of the disease and the analysis of the overall costs of therapy.A careful selection of patients may lead to successful nonsurgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones.The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations,suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe),or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis,might be proposed as additional approaches for treating cholesterol gallstones.In this review we discuss old,recent and future perspectives on medical treatment of cholesterol cholelithiasis. | Piero Portincasa Agostino Di Ciaula Leonilde Bonfrate David QH Wang | 2012 | World Journal of Gastrointestinal Pharmacology and Therapeutics2012，3，2： | 21 |
| 5 | Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the“rendezvous” technique显示文摘BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient's age.Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic surgery,together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones.DATA SOURCES:We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using Pub Med, EMBASE, Scopus and the Cochrane Library Central.RESULTS:The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous.CONCLUSIONS:Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers. | Giuseppe Tarantino Paolo Magistri Roberto Ballarin Giacomo Assirati Antonio Di Cataldo Fabrizio Di Benedetto | 2017 | Hepatobiliary & Pancreatic Diseases International2017，16，6： | 18 |
| 6 | Liver diseases in pregnancy: Diseases not unique to pregnancy显示文摘Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver.Liver disease can cause significant morbidity and mortality in both pregnant women and their infants.Few challenges arise in reaching an accurate diagnosis in light of such physiological changes.Laboratory test results should be carefully interpreted and the knowledge of what normal changes to expect is prudent to avoid clinical misjudgment.Other challenges entail the methods of treatment and their safety for both the mother and the baby.This review summarizes liver diseases that are not unique to pregnancy.We focus on viral hepatitis and its mode of transmission,diagnosis,effect on the pregnancy,the mother,the infant,treatment,and breast-feeding.Autoimmune hepatitis,primary biliary cirrhosis,primary sclerosing cholangitis,Wilson’s disease,Budd Chiari and portal vein thrombosis in pregnancy are also discussed.Pregnancy is rare in patients with cirrhosis because of the metabolic and hormonal changes associated with cirrhosis.Variceal bleeding can happen in up to 38%of cirrhotic pregnant women.Management of portal hypertension during pregnancy is discussed.Pregnancy increases the pathogenicity leading to an increase in the rate of gallstones.We discuss some of the interventions for gallstones in pregnancy if symptoms arise.Finally,we provide an overview of some of the options in managing hepatic adenomas and hepatocellular carcinoma during pregnancy. | Ashraf A Almashhrawi Khulood T Ahmed Rubayat N Rahman Ghassan M Hammoud Jamal A Ibdah | 2013 | World Journal of Gastroenterology2013，19，43： | 17 |
| 7 | Ursodeoxycholic acid therapy in gallbladder disease,a story not yet completed显示文摘Gallstone disease represents an important issue in the healthcare system.The principal non-invasive nonsurgical medical treatment for cholesterol gallstones is still represented by oral litholysis with bile acids.The first successful and documented dissolution of cholesterol gallstones was achieved in 1972.Since then a large number of investigators all over the world,have been dedicated in biochemical and clinical studies on ursodeoxycholic acid(UDCA),demonstrating its extreme versatility.This editorial is aimed to provide a brief review of recent developments in UDCA use,current indications for its use and,the more recent advances in understanding its effects in terms of an antiinflammatory drug. | Michele Pier Luca Guarino Silvia Cocca Annamaria Altomare Sara Emerenziani Michele Cicala | 2013 | World Journal of Gastroenterology2013，19，31： | 16 |
| 8 | Ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones显示文摘AIM To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct(CBD) stones.METHODS From April 2014 to May 2016, 15 consecutive patients(6 men and 9 women) aged 45-86(mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder. RESULTS All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain(n = 1), abdominal distension(n = 1), and fever(n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred. CONCLUSION For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones. | Hai-Yang Chang Chang-Jun Wang Bin Liu Yong-Zheng Wang Wu-Jie Wang Wei Wang Dong Li Yu-Liang | 2018 | World Journal of Gastroenterology2018，24，39： | 15 |
| 9 | Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones:A novel technique显示文摘AIM To evaluate the clinical efficacy and safety of an innovative percutaneous transhepatic extraction and balloon dilation(PTEBD) technique for clearance of gallbladder stones in patients with concomitant stones in the common bile duct(CBD).METHODS The data from 17 consecutive patients who underwent PTEBD for clearance of gallbladder stones were retrospectively analyzed. After removal of the CBD stones by percutaneous transhepatic balloon dilation(PTBD), the gallbladder stones were extracted to the CBD and pushed into the duodenum with a balloon after dilation of the sphincter of Oddi. Large stones were fragmented using a metallic basket. The patients were monitored for immediate adverse events including hemorrhage, perforation, pancreatitis, and cholangitis. During the two-year follow-up, they were monitored for stone recurrence, reflux cholangitis, and other longterm adverse events.RESULTS Gallbladder stones were successfully removed in 16(94.1%) patients. PTEBD was repeated in one patient. The mean hospitalization duration was 15.9 ± 2.2 d. Biliary duct infection and hemorrhage occurred in one(5.9%) patient. No severe adverse events, including pancreatitis or perforation of the gastrointestinal or biliary tract occurred. Neither gallbladder stone recurrence nor refluxing cholangitis had occurred two years after the procedure.CONCLUSION Sequential PTBD and PTEBD are safe and effective for patients with simultaneous gallbladder and CBD stones. These techniques provide a new therapeutic approach for certain subgroups of patients in whom endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy or surgery is not appropriate. | Bin Liu De-Shun Wu Pi-Kun Cao Yong-Zheng Wang Wu-Jie Wang Wei Wang Hai-Yang Chang Dong Li Xiao Li Yancu Hertzanu Yu-Liang Li | 2018 | World Journal of Gastroenterology2018，24，33： | 15 |
| 10 | ApoB-100, ApoE and CYP7A1 gene polymorphisms in Mexican patients with cholesterol gallstone disease显示文摘AIM: To determine the possible association of the ApoB100 (Xba Ⅰ ), ApoE (Hha Ⅰ ) and CYP7A1 (Bsa Ⅰ ) gene polymorphisms, with the development of cholesterol gallstone disease (GD) in a Mexican population. METHODS: The polymorphisms were analyzed by polymerase chain reaction followed by restriction fragment length polymorphism, in two groups matched by ethnicity, age and sex: patients with GD (n = 101) and stone-free control subjects (n = 101). RESULTS: Allelic frequencies in patients and controls were: 34.16% vs 41.58% (P = 0.124) for X+of ApoB-100; 4.46% vs 5.94% (P = 0.501) for E2, 85.64% vs 78.22% (P = 0.052) for E3, 9.90% vs 15.84% (P = 0.075) for E4 of ApoE; and 25.74% vs 27.72% (P = 0.653) for C of CYP7A1. Differences in genotypic frequencies between the studied groups were not significant (P < 0.05). CONCLUSION: These results demonstrated that no association exists between the studied polymorphisms and cholelithiasis in this high prevalent population. | Sánchez-Cuén Jaime Aguilar-Medina Maribel Arámbula-Meraz Eliakym Romero-Navarro José Granados Julio Sicairos-Medina Laura Ramos-Payán Rosalío | 2010 | World Journal of Gastroenterology2010，16，37： | 14 |
| 11 | Biliary microlithiasis,sludge,crystals, microcrystallization,and usefulness of assessment of nucleation time显示文摘BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were'biliary microlithiasis','biliary sludge','bile crystals','cholesterol crystallisation','bile microscopy','microcrystal formation of bile','cholesterol monohydrate crystals','nucleation time of cholesterol','gallstone formation','sphincter of Oddi dysfunction'and'idiopathic pancreatitis'.Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation. | Vasitha Abeysuriya Kemal I Deen Navarathne MM Navarathne | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，3： | 13 |
| 12 | Endoscopic papillary large balloon dilation for the removal of bile duct stones显示文摘Endoscopic papillary large balloon dilation(EPLBD)with endoscopic sphincterotomy(EST)has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy(EML)for the removal of large or difficult bile duct stones.Furthermore,EPLBD without EST was recently introduced as its simplified alternative technique.Thus,we systematically searched PubMed,Medline,the Cochrane Library and EMBASE,and analyzed all gathered data of EPLBD with and without EST,respectively,by using a single standardized definition,reviewing relevant literatures,published between 2003and June 2013,where it was performed with largediameter balloons(12-20 mm).The outcomes,including the initial success rate,the rate of needs for EML,and the overall success rate,and adverse events were assessed in each and compared between both of two procedures:'EPLBD with EST'and'EPLBD without EST'.A total of 2511 procedures from 30 published articles were included in EPLBD with EST,while a total of413 procedures from 3 published articles were included in EPLBD without EST.In the results of outcomes,the overall success rate was 96.5%in EPLBD with EST and97.2%in EPLBD without EST,showing no significant difference between both of them.The initial success rate(84.0%vs 76.2%,P<0.001)and the success rate of EPLBD without EML(83.2%vs 76.7%,P=0.001)was significantly higher,while the rate of use of EML was significantly lower(14.1%vs 21.6%,P<0.001),in EPLBD with EST.The rate of overall adverse events,pancreatitis,bleeding,perforation,other adverse events,surgery for adverse events,and fatal adverse events were 8.3%,2.4%,3.6%,0.6%,1.7%,0.2%and 0.2%in EPLBD with EST and 7.0%,3.9%,1.9%,0.5%,0.7%,0%and 0%in EPLBD without EST,respectively,showing no significant difference between both of them.In conclusion,recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events,when performed under appropriate guidelines. | Jin Hong Kim Min Jae Yang Jae Chul Hwang Byung Moo Yoo | 2013 | World Journal of Gastroenterology2013，19，46： | 12 |
| 13 | Comparatively lower postoperative hepatolithiasis risk with hepaticocholedochostomy versus hepaticojejunostomy显示文摘BACKGROUND:Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis.Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) technique and applied it in hepatolithiasis patients who had an approximately normal gallbladder and sphincter of Oddi.However,the technique is controversial.In the present study,a canine model was established for hepatocholangioplasty (HC) and hepaticojejunostomy (HJ) to simulate STHG and Roux-en-Y cholangiojejunostomy in the clinic,respectively.Then,the alterations of bile components in the vicinity of the anastomosis were compared.This may provide an experimental guide for choosing an optimal technique for the treatment of hepatolithiasis in the clinic.METHODS:The animals were randomly separated into a control group (5 dogs) and a model group (stenosis of the common bile duct;24 dogs).The 24 dogs in the model group were randomly divided into an HC group and an HJ group (12/group).Bile was collected from the bile duct at 1 and 5 months after the operation,and the bile components were determined.RESULTS:The levels of total bile acid,cholesterol,total bilirubin,and phospholipid in the HC group were higher than those in the HJ group (P<0.05).However,no statistical difference was seen in unconjugated bilirubin and calcium ions.The mucin level in bile in the HC group was lower than that in the HJ group at 5 months after the operation (P<0.05).The postoperative lipid peroxidation level was remarkably lower than that in the HJ group (P<0.05).However,the superoxide dismutase level was remarkably higher than that in the HJ group (P<0.05).Finally,a significant difference was found in the positive bacterial culture rate in bile between the groups.CONCLUSION:Changes of bile components near the anastomosis after HC might be more preferable for preventing hepatolithiasis formation than HJ. | Zhang, Xiao-Jin Jiang, Yi Wang, Xu Tian, Fu-Zhou Lv, Li-Zhi | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 12 |
| 14 | Helicobacter pylori infection is associated with gallstones: Epidemiological survey in China显示文摘AIM: To elucidate the prevalence and risk factors for gallstones, primarily focusing on Helicobacter pylori(H. pylori) infection. METHODS: A total of 10016 Chinese subjects, who had undergone physical examination, fasting 13 C urea breath test and abdominal ultrasonography, had sufficient blood test data, and had finished a questionnaire, were included in this cross-sectional study. Participants(n = 1122) who had previous eradication of H. pylori were studied separately. RESULTS: Gallstones were discovered in 9.10% of men and 8.58% of women, with no significant sex difference. Multivariate analyses displayed that age, aspartate aminotransferase, total cholesterol, H. pylori infection, hepatitis C virus(HCV) infection, and fattyliver had a significant association with gallstones(P < 0.05). Successive multiple logistic regression analysis including index of odds ratio(OR) and standardized coefficient(β) indicated that older age(OR/β = 1.056/0.055), H. pylori infection(OR/β = 1.454/0.109), HCV infection(OR/β = 1.871/0.123), and fatty liver(OR/β = 1.947/0.189) had a significant positive association with gallstones. After age stratification, H. pylori infection and fatty liver still had a significant positive association with gallstones in any age-specific groups, whereas HCV infection had a significant positive association in patients aged > 40 years. The prevalence of gallstones among H. pylori-positive, H. pylori-eradicated, and H. pylori-negative subjects was 9.47%, 9.02%, and 8.46%, respectively. The matched analysis showed that gallstones among H. pylori eradicated subjects was significantly lower compared with H. pylori-positive subjects(P < 0.05).CONCLUSION: H. pylori infection and fatty liver have a significant positive association with gallstones. H. pylori eradication may lead to prevention of gallstones. | Fen-Ming Zhang Chao-Hui Yu Hong-Tan Chen Zhe Shen Feng-Ling Hu Xiao-Ping Yuan Guo-Qiang Xu | 2015 | World Journal of Gastroenterology2015，21，29： | 11 |
| 15 | Gallstone-related complications after Roux-en-Y gastric bypass:a prospective study显示文摘BACKGROUND: Gastric bypass is a widespread bariatric procedure that carries a high incidence of gallstone formation postoperatively. Controversy exists regarding the importance and consequences of gallstones in these patients. There are surgeons who consider gallstone-related complications after gastric bypass important enough to require routine removal of the gallbladder during gastric bypass (prophylactic cholecystectomy). However, this can lead to increased costs and risks. This study aimed to identify complications related to cholelithiasis after Roux-en-Y gastric bypass (RYGBP). METHODS: This is a prospective observational study of 40 morbidly obese patients free of gallbladder disease. The patients underwent open RYGBP at a public hospital in Brazil from February to October 2007. They were followed up clinically and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Of the patients, 38 patients were followed up for 3 years. RESULTS: Eleven patients (28.9%) developed cholelithiasis, four (10.5%) experienced biliary pain, and 2 suffered from acute biliary pancreatitis (5.3%). These patients had their gallbladders removed laparoscopically. No patient presented with acute cholecystitis, choledocholithiasis, or bile duct dilation during the follow-up period. There were no deaths. CONCLUSIONS: Gallstone-related complications after RYGBP were relatively common. Some of these complications, like acute pancreatitis, are known to have potentially severe outcomes. It seems reasonable to perform cholecystectomy during gastric bypass in the presence of cholelithiasis or after this procedure if gallstones develop. | Rachid G Nagem Alcino Lázaro-da-Silva Rafael Morroni de Oliveira Valter Garcia Morato | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，6： | 10 |
| 16 | Rat model of cholelithiasis with human gallstones implanted in cholestasis-induced virtual gallbladder显示文摘AIM:To facilitate translational research on cholelithiasis,we have developed a rat model of human gallstones by exploiting the unique biliopancreatic features of this species.METHODS:Under anesthesia,16 adult rats of equal genders underwent two times of abdominal surgery.First,their common bile duct(CBD)was ligated to cause cholestasis by total biliary obstruction(TBO).On day 0,1,3,7,14,21 and 28 after TBO,magnetic resonance imaging(MRI)was conducted to monitor the dilatation of the CBD,and blood was sampled to analyze total serum bilirubin(TSB).Secondly,on day 30,the abdomen was re-opened and gallstone(s)collected from human patients were implanted in the dilated CBD asa virtual gallbladder(VGB),which was closed by suture ligation.This rat cholelithiasis model was examined by MRI,clinical observation,microcholangiography and histology.RESULTS:All rats survived two laparotomies.After ligation,the CBD was dilated to a stable size of 4 to30 mm in diameter on day 21-28,which became a VGB.The rats initially showed signs of jaundice that diminished over time,which paralleled with the evolving TSB levels from 0.6±0.3 mg/d L before ligation,through a peak of 10.9±1.9 mg/dL on day 14,until a nearly normalized value after day 28.The dilated CBD with thickened wall allowed an incision for implantation of human gallstones of 1-10 mm in diameter.The rat cholelithiasis was proven by in vivo MRI and postmortem microcholangiography and histomorphology.CONCLUSION:A rat model cholelithiasis with human gallstones has been established,which proves feasible,safe,reliable,nontoxic and cost-effective.Given the gallstones of human origin,applications of this model may be of help in translational research such as optical detection and lysis of gallstones by systemic drug administration. | Marlein Miranda Cona Yewei Liu Ting Yin Yuanbo Feng Feng Chen Stefaan Mulier Yue Li Jian Zhang Raymond Oyen Yicheng Ni | 2016 | World Journal of Methodology2016，6，2： | 7 |
| 17 | Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention显示文摘AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children's hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures. | Douglas S Fishman Bruno P Chumpitazi Isaac Raijman Cynthia Man-Wai Tsai E O’Brian Smith Mark V Mazziotti Mark A Gilger | 2016 | World Journal of Gastrointestinal Endoscopy2016，8，11： | 6 |
| 18 | Nonalcoholic fatty liver disease is associated with benign gastrointestinal disorders显示文摘AIM:To explore associations between nonalcoholic fatty liver disease(NAFLD)and benign gastrointestinal and pancreato-biliary disorders.METHODS:Patient demographics,diagnoses,and hospital outcomes from the 2010 Nationwide Inpatient Sample were analyzed.Chronic liver diseases were identified using International Classification of Diseases,the 9thRevision,Clinical Modification codes.Patients with NAFLD were compared to those with other chronic liver diseases for the endpoints of total hospital charges,disease severity,and hospital mortality.Multivariable stepwise logistic regression analyses to assess for the independent association of demographic,comorbidity,and diagnosis variables with the event of NAFLD(vs other chronic liver diseases)were also performed.RESULTS:Of 7800441 discharge records,32347(0.4%)and 271049(3.5%)included diagnoses of NAFLD and other chronic liver diseases,respectively.NAFLD patients were younger(average 52.3 years vs55.3 years),more often female(58.8%vs 41.6%),less often black(9.6%vs 18.6%),and were from higher income areas(23.7%vs 17.7%)compared to counterparts with other chronic liver diseases(all P<0.0001).Diabetes mellitus(43.4%vs 28.9%),hypertension(56.9%vs 47.6%),morbid obesity(36.9%vs 8.0%),dyslipidemia(37.9%vs 15.6%),and the metabolic syndrome(28.75%vs 8.8%)were all more common among NAFLD patients(all P<0.0001).The average total hospital charge($39607 vs$51665),disease severity scores,and intra-hospital mortality(0.9%vs6.0%)were lower among NALFD patients compared to those with other chronic liver diseases(all P<0.0001).Compared with other chronic liver diseases,NAFLD was significantly associated with diverticular disorders[OR=4.26(3.89-4.67)],inflammatory bowel diseases[OR=3.64(3.10-4.28)],gallstone related diseases[OR=3.59(3.40-3.79)],and benign pancreatitis[OR=2.95(2.79-3.12)]on multivariable logistic regression(all P<0.0001)when the latter disorders were the principal diagnoses on hospital discharge.Similar relationships were observed when the latter disorders were associated diagnoses on hospital discharge.CONCLUSION:NAFLD is associated with diverticular,inflammatory bowel,gallstone,and benign pancreatitis disorders.Compared with other liver diseases,patients with NAFLD have lower hospital charges and mortality. | Srinevas K Reddy Min Zhan H Richard Alexander Samer S El-Kamary | 2013 | World Journal of Gastroenterology2013，19，45： | 4 |
| 19 | 在每日的内视镜检查法常规挑选操作员 choledochoscopy 和它的角色显示文摘 Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice.However,neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other imaging procedures allow a safe diagnosis of the lesions.Therefore choledochoscopy may be a useful diagnostic procedure in macroscopic assessing lesions of the bile duct.Even if the diagnostic sensitivity and specificity is not sufficient,first studies suggest an enhanced diagnostic accuracy for choledochoscopy.Since the progress of choledochoscopy has started in the 1970 different improvements were achieved.Meanwhile,the examination can be performed by an examiner and samples can be taken.Image and Resolution quality has improved over the past years,also.The SpyGlass system is a technically advanced cholangioscopic device to provide endoscopic diagnosis in case of inconclusive bile duct findings.Further more,two more lumina allow specific biopsy forceps and optical fibers for electrohydraulic or laser lithotripsy.The most frequent useful insert of SpyGlass in clinical practice are in complex gallstones and bile duct lesions of unclear dignity. | Arthur Hoffman Johannes Wilhelm Rey Ralf Kiesslich | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，5： | 3 |
| 20 | Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis显示文摘BACKGROUND:Few studies have assessed microflora and their antibiotic sensitivity in normal bile and lithogenic bile with different types of gallstones. METHODS:We performed a case control study of 70 bile samples(35 cholesterol and 35 pigment stones from 51 females and 19 males,aged 21-72 years with a median age of 37 years)from patients who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis,and 20 controls(14 females and 6 males,aged 33-70 years with a median age of 38 years)who underwent laparotomy and had no gallbladder stone shown by ultrasound scan.The bile samples were aerobically cultured to assess microflora and their antibiotic susceptibility.The procedures were undertaken under sterile conditions. RESULTS:Thirty-eight(54%)of the 70 patients with gallstones had bacterial isolates.Nine isolates(26%)were from cholesterol stone-containing bile and 29 isolates (82%)from pigment stone-containing bile(P=0.01,t test). Twenty-eight of these 38(74%)bile samples were shown positive only after enrichment in brain heart infusion medium(BHI)(P=0.02,t test).The overall bacterial isolates from bile samples revealed E.coli predominantly,followed by P.aeruginosa,Enterococcus spp.,Klebsiella spp.and S. epidermidis.There were no bacterial isolates in the bile of controls after either direct inoculation or enrichment in BHI.CONCLUSIONS:Bacterial isolates were found in pigment stone-containing bile.Non-lithogenic bile revealed no bacteria,showing an association between gallstone formation and the presence of bacteria in bile.Antibiotic sensitivity patterns of isolated organisms were similar irrespective of the type of stone. | Vasitha Abeysuriya Kemal Ismil Deen Tamara Wijesuriya Sujatha Senadera Salgado | 2008 | Hepatobiliary & Pancreatic Diseases International2008，7，6： | 3 |
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