Recurrent Pyogenic Cholangitis: Disease Characteristics and Patterns of Recurrence (original) (raw)
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Surgical management decreases disease recurrence risk in recurrent pyogenic cholangitis
Anz Journal of Surgery, 2017
Background: Recurrent pyogenic cholangitis (RPC) has a high risk of disease recurrence. We present our experience with RPC and examine the factors associated with disease recurrence. Methods: We performed a retrospective review of all patients with RPC treated at two tertiary institutions between January 1990 and December 2013. Patients with liver atrophy and/or abscess were categorized as being associated with parenchymal disease (PD). Results: We studied 157 patients with a median age of 59.0 (interquartile range (IQR): 47.0-70.0) years and a median follow-up duration of 71.0 (IQR: 26.0-109.0) months. There were 64 (40.8%) and 93 (59.2%) patients with and without associated PD, respectively. Disease recurrence rate was 43.9% in our overall cohort through the course of follow-up. Surgical treatment was an independent prognostic factor for decreased disease recurrence risk (hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.18-0.87, P = 0.021). Stratified analysis revealed that liver resection was prognostic for lower risk of disease recurrence among patients with PD (HR 0.38, 95% CI 0.15-0.94, P = 0.036), while biliary bypass was prognostic for lower risk of disease recurrence among patients without PD (HR 0.30, 95% CI 0.15-0.61, P = 0.001). The overall post-operative complication rate among surgically treated patients was 31.1%, and the presence of bilobar stones was found to be independently associated with higher odds of post-operative complications (odds ratio 3.51, 95% CI 1.26-9.81, P = 0.017). Conclusion: Surgical treatment is associated with decreased recurrence risk in RPC, but with significant post-operative morbidity. Where surgery is deemed appropriate, patients with and without PD are likely to benefit from liver resection and biliary bypass, respectively.
A Stop-gap Procedure in the Management of High Risk Patients with Acute Biliary Tract Diseases
2018
Introduction: Acute biliary tract diseases constitute a major portion of gastrointestinal disorders throughout world and include acute cholecystitis and acute cholangitis. Study aimed to assess efficacy and safety of percutaneous cholecystostomy (PC) in high risk patients with acute biliary tract diseases. Material and methods: The study was carried-out in high risk patients unfit for general anaesthesia with acute calculous/ acalculous cholecystitis, empyema/mucocele gallbladder and patients having acute cholangitis with failed ERCP and PTC. The catheter position was established by a cholecystogram done postoperatively. Results: 36 patients underwent ultrasound guided PC. 66.7% (24) had empyema-gallbladder, 16.7% (6) had mucocele of gallbladder and 11.1% (4) patients were diagnosed as acute calcular cholecystitis 5.6% (2) patients had acute pyogenic cholangitis with failed ERCP. All the patients had atleast one uncontrolled comorbidiy and none was fit for general anaesthesia. The post-procedure hospital stay was 3 to 6 days. Rapid clinical and biochemical improvement was observed in all patients after the procedure. There was statistically significant pain relief and reduction in mean total leukocyte count within 48 hours of procedure. 32 out of 36 procedures were done via trans-peritoneal route. Bile cultures yielded growth of E Coli in 10 (28.8%) patients, klebsela in 8 (22.86%), pseudomonas aeruginosa in 6 (17.14%) and Proteus mirabilis in 11.43% of patients. No major complication was recorded in our study. Catheter was removed after a mean of 25.25 days. Conclusion: USG guided PC is a safe and effective stopgap procedure for treating high-risk patients with acute biliary tract diseases. Once the acute symptoms diminish or resolve, it should be followed by elective surgery.
Nonoperative Treatment of Biliary Tract Disease
Archives of Surgery, 1998
he rise of minimally invasive surgical techniques during the past 20 years has been one of the more dramatic developments in modern medicine. Minimally invasive procedures are now widely accepted for treatment of diseases involving many different organ systems. Minimally invasive procedures may be more common and more accepted in the treatment of diseases of the biliary tract than in any other area. The development of laparoscopic cholecystectomy serves as a benchmark for minimally invasive procedures, and it is now the standard of care for the treatment of cholelithiasis. Today, not only is laparoscopic cholecystectomy one of the most common operations performed in the United States, but many new techniques have been developed that allow minimally invasive treatment of a variety of biliary tract diseases. The development of nonoperative techniques for treatment of biliary tract disease has accompanied the rapid developments in minimally invasive surgical techniques. This article describes the nonoperative treatment of biliary tract disease.
2008
Objective To assess outcomes of percutaneous transjejunal biliary intervention (PTJBI) in terms of success and effectiveness in patients with a Roux-en-Y hepaticojejunostomy for benign biliary strictures and stones. Methods Clinical and radiographic records of 63 patients with a Roux-en-Y choledochojejunostomy or hepaticojejunostomy for benign disease who underwent at least one PTJBI between 1986 and 2007 were reviewed. Effectiveness was determined by successful access rate, rates of stricture dilatation and/or stone extraction, morbidity, complications and hospitalisation. Results PTJBI was attempted 494 times. Successful access to the Roux-en-Y was accomplished in 93% of interventions. After access to the Roux-en-Y was granted, all strictures were effectively dilated. Ninety-seven percent of extraction attempts of intrahepatic calculi were successful. The median number of interventions per patient was five. The median interval between interventions was 51.5 weeks (range 2.7-1,279.6 weeks). The early complication rate was 3%. Morbidity, measured in terms of cholangitis episodes was 14%, in 25 out of 63 patients. Mean hospitalisation was 4.1 nights per year. Conclusion PTJBI is safe and effective in treating benign biliary strictures and/or calculi. High success rates and short hospitalisation periods, together with few complications make it a well-accepted and integral part of managing complex biliary problems.
Seminars in interventional radiology, 2016
Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are applicable for the diagnosis and treatment of biliary system pathologies, the majority of which may be performed in conjunction with one another. The backbone of nearly all of these interventions is percutaneous transhepatic cholangiography for opacification of the biliary tree, after which any number of therapeutic or diagnostic modalities may be pursued. We describe an overview of the instrumentation and technical approaches for several fundamental interventional procedures, including percutaneous transhepatic cholangiography and internal/external biliary drainage, endobiliary biopsy techniques, cholangioscopy, cholangioplasty and biliary stenting, biliary stone extraction, and intraluminal brachytherapy.
Electronic Poster-Biliary (EP223-EP258)
2021
P. J. Gil Vázquez, D. Ferreras Martinez, B. Gómez Pérez and F. Sánchez Bueno Hospital Clínico Universitario Virgen de la Arrixaca, Spain Introduction: The standard treatment of choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP). In this way, it needs two interventions: ERCP and laparoscopic cholecystectomy (LC), so it is necessary two anesthetic processes, more possibilities of failure, complications, hospital stay and more expenses. Thanks to laparoscopic common bile duct exploration (LCBE) complete treatment is possible with a single intervention. Method: We designed this prospective, non-randomized study to analyze LCBE approach in terms of hospital stay and cost-effectiveness. Results: There are 118 patients in the study (67 women; mean age of 69.8 17.3 years old). Sixty-six patients received ERCP+LC management. Fifteen of them failed to clean the bile duct. LCBE was carried out in 59 patients (49 plus 11 ERCP failure). Seven of them required conversion...