1/28. Laparoscopic treatment for common bile duct stones by transcystic papilla balloon dilatation technique.The laparoscopic transcystic common bile duct (CBD) approach is becoming increasingly more refined as an ideal technique to deal with gallbladder stones (GBS) and common bile duct stones (CBDS) during a single operation. Our method, transcystic CBD exploration and papilla balloon dilatation (PBD), is an easier, safer, and less invasive technique than the transcystic approaches that have previously been reported. With our method, a sheath is introduced through the cystic duct into the CBD in order to allow catheter exchange, and the CBDS is flushed out through the papilla into the duodenum after PBD. We applied our new technique, without complication, to a patient with GBS and CBDS. Our technique is one of the safest, easiest, and least invasive methods for the treatment of patients with GBS and CBDS.- - - - - - - - - - ranking = 1keywords = papilla (Clic here for more details about this article) |
2/28. Percutaneous papillary balloon dilatation as a therapeutic option for cholecystocholedocholithiasis in the era of laparoscopic cholecystectomy.The present study was conducted to evaluate the effectiveness of percutaneous papillary balloon dilatation (PPBD) as a therapeutic option for cholecystocholedocholithiasis, in combination with laparoscopic cholecystectomy (LC). A total of 15 patients with both bile duct and gallbladder stones were clinically investigated. In 14 patients, PPBD was performed 2 to 7 days prior to LC, while in the remaining patient, PPBD was performed immediately after LC under general anesthesia in one continuous session. The bile duct stones were successfully pushed out into the duodenum in all the patients, seven of whom required two sessions for complete stone clearance, while the other eight needed only one session. Two patients had bile duct stones larger than 12 mm in diameter, necessitating electrohydraulic lithotripsy under cholangioscopy. The insertion of a percutaneous transhepatic biliary drainage tube did not cause intra-abdominal adhesions severe enough to contraindicate the use of LC. The operation times for LC varied from 80 to 184 min, with a mean operation time of 132 min, and the average postoperative and overall hospital stays were 9 and 26 days, respectively. There were no deaths or major complications, apart from transient hyperamylasemia. The findings of this study indicate that PPBD combined with LC is a safe and effective therapeutic option for cholecystocholedocholithiasis.- - - - - - - - - - ranking = 0.83333333333333keywords = papilla (Clic here for more details about this article) |
3/28. Successful treatment of percutaneous transhepatic papillary dilation in patients with obstructive jaundice due to common bile duct stones after Billroth II gastrectomy: report of two emergent cases.Successful treatment of two patients with obstructive jaundice due to choledocholithiasis after Billroth II gastrectomy was performed by elimination of stones by percutaneous transhepatic balloon dilatation of the sphincter of oddi. Patient 1 was an 82-year-old man and Patient 2 was a 73-year-old man. Both patients presented with obstructive jaundice. The papilla was not observed in either patient because of previous Billroth II gastrectomy. Because an endoscopic approach was impossible, percutaneous transhepatic cholangiodrainage (PTCD) was performed to alleviate jaundice. choledocholithiasis was treated as follows: The sphincter of oddi was dilated by percutaneous transhepatic balloon, and stone particles were removed from the papilla with a stone-eliminating balloon catheter via the same route of PTCD. This method is less invasive than the percutaneous transhepatic cholangioscopic method, and the use of existing appliances such as a balloon for papillary dilation is possible. Hence, this method appears to be an effective and simple method for the treatment of choledocholithiasis after gastrectomy that is difficult to treat endoscopically.- - - - - - - - - - ranking = 1.1666666666667keywords = papilla (Clic here for more details about this article) |
4/28. Temporary use of an accuflex stent for unextractable common bile duct stones.Endoscopic management has become the main therapeutic approach for the extraction of common bile duct (CBD) stones, and successful removal can be achieved in 80-90% patients using conventional balloon and basket techniques. However, if it is difficult to completely fragment a stone, or to clear the CBD, which may occur for a variety of reasons, the therapeutic problem will remain. When bile duct stones can not be removed, a viable management option is to place a biliary stent to ensure drainage. However, recent studies of long-term biliary stenting, with a plastic stent, showed a relatively high rate of morbidity and mortality. We report an alternative, unique treatment for unextractable common bile duct stones, using the temporal placement of an expandable metallic stent (EMS) to facilitate passage of fragments through the papilla.- - - - - - - - - - ranking = 0.16666666666667keywords = papilla (Clic here for more details about this article) |
5/28. Transhepatic balloon sphincteroplasty for bile duct stones after total gastrectomy.Previous upper gastrointestinal surgery with the construction of a Roux-en-Y jejunal loop may prevent endoscopic access to the second part of the duodenum. We report a technique of percutaneous transhepatic balloon sphincteroplasty to facilitate the removal of common bile duct (CBD) stones. A 67-year-old woman presented with a 1-week history of right upper quadrant abdominal pain and fever, deranged liver function tests, and dilated intrahepatic ducts. The patient had previously had a total gastrectomy with Roux-en-Y reconstruction for a high-grade B-cell lymphoma of the stomach. Peroral endoscopic access to the biliary tree was unsuccessful. Percutaneous transhepatic cholangiography confirmed the presence of CBD stones. Over a period of 8 weeks, sequential dilatation of the percutaneous tract was undertaken. After a further 2 weeks, percutaneous choledochoscopy was performed. Several large stones were visualized and then fragmented. The choledochoscope would not pass through to the duodenum due to postinflammatory stenosis of the papilla, so the papilla was dilated with an endoscopic balloon. The remaining fragments were pushed through, and the duct was thoroughly irrigated with saline. Repeat cholangiography confirmed a clear CBD. Balloon catheter sphincteroplasty and biliary stone extrusion into the duodenum is a novel technique that enabled clearance of the CBD in an elderly patient who may otherwise have required open surgical exploration.- - - - - - - - - - ranking = 0.33333333333333keywords = papilla (Clic here for more details about this article) |
6/28. Pyloric gland-type tubular adenoma superimposed on intraductal papillary mucinous tumor of the pancreas. Pyloric gland adenoma of the pancreas.We report a rare case of pyloric gland-type tubular adenoma of the main pancreatic duct. It was a grossly visible polypoid nodule and was composed of closely packed pyloric-type glands. This adenoma was present within an intraductal papillary mucinous adenoma (IPMA). In this IPMA lesion, aggregations of pyloric-type glands were occasionally observed, and most of the cells including ductal lining cells expressed pyloric gland-type mucin. The IPMA of the present case showed more extensive pyloric gland metaplasia or differentiation than commonly noted in IPMAs. We consider this pyloric gland-type tubular adenoma to be derived from a selective growth of IPMA cells showing pyloric gland metaplasia.- - - - - - - - - - ranking = 0.83333333333333keywords = papilla (Clic here for more details about this article) |
7/28. Use of the transcystic guidewire in single-intervention treatment for cholecysto-choledocholithiasis. A case report and technical notes.Videolaparoendoscopic treatment of choledocholithiasis in a single stage is an important option for this disease. We currently adopt this approach to choledocholithiasis in our department. We report here the case of a woman with stones in the biliary tract and gallbladder. After videolaparoscopic cholecystectomy we performed a transcystic cholangiography. A guidewire was used to show Vater's papilla during endoscopic papillosphinterotomy, because this was in a duodenal diverticulum that made it impossible to cannulate the papilla. We propose this method in all those cases in which, for anatomical reasons, the papilla cannot be easily cannulated.- - - - - - - - - - ranking = 0.5keywords = papilla (Clic here for more details about this article) |
8/28. Combination therapy of laparoscopic cholecystectomy and endoscopic transpapillary lithotripsy for both cholecystolithiasis and choledocholithiasis.This report describes five patients with cholecystolithiasis and choledocholithiasis who were treated by combination endoscopic extraction of common bile-duct stones with sphincterotomy (EST) and laparoscopic cholecystectomy (LC). Following this combination procedure the patients were relieved completely of obstructive jaundice and right upper quadrant pain, leaving only small trocar insertion scars made during the short course of hospitalization. The combination therapy of EST and LC will be recommended for this kind of patient as a minimally invasive procedure.- - - - - - - - - - ranking = 0.66666666666667keywords = papilla (Clic here for more details about this article) |
9/28. Bile duct carcinoma arising in metaplastic biliary epithelium of the intestinal type: a case report.We report herein a case of distal bile duct carcinoma showing intestinal differentiation diagnosed 3 years after endoscopic sphincterotomy for choledocholithiasis. The diagnostic problem in this case was that the granular mucosa, which is a typical finding of superficial mucosal extension of bile duct carcinoma in general, was interpreted as hyperplasia accompanying metaplasia in cholangioscopic biopsy. Discrimination of superficial mucosal cancer extension from hyperplastic mucosa with metaplastic changes was impossible using cholangioscopic examination. In our case, reflux and stasis of the duodenal and pancreatic juice into the biliary tract might have occurred because of abnormal function of the papilla of Vater following endoscopic sphincterotomy. It might be suggested that endoscopic sphincterotomy contributed to the metaplastic changes in the bile duct mucosa in our case.- - - - - - - - - - ranking = 0.16666666666667keywords = papilla (Clic here for more details about this article) |
10/28. A novel technique for endoscopic sphincterotomy when using a percutaneous transhepatic cholangioscope in patients with an endoscopically inaccessible papilla.BACKGROUND: Endoscopic sphincterotomy is difficult and sometimes impossible in patients who have undergone gastrectomy or partial gastrectomy with Billroth II reconstruction. For such patients, a novel technique was developed in which endoscopic sphincterotomy is performed via percutaneous transhepatic cholangioscopy. This report describes an initial experience with this technique. methods: After dilation of the percutaneous fistula, a cholangioscope with a push-type sphincterotome attached was inserted into the bile duct via the fistula and then through the papilla into the duodenum. The tip of the instrument then was retroverted to obtain a frontal view of the papilla. Then, a sphincterotomy incision was extended to the proximal, orad margin of the papillary eminence. OBSERVATIONS: Percutaneous transhepatic biliary drainage was performed in 3 patients with obstructive jaundice and bile duct stones. In all patients, percutaneous transhepatic cholangioscopic sphincterotomy was performed successfully, without procedure-related complication. Thereafter, all stones and stone fragments cleared from the duct by spontaneous migration. CONCLUSIONS: Endoscopic sphincterotomy via percutaneous transhepatic cholangioscopy potentially is an innovative technique for endoscopic sphincterotomy in patients with an endoscopically inaccessible papilla.- - - - - - - - - - ranking = 1.3333333333333keywords = papilla (Clic here for more details about this article) |
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