Caroli disease is an infrequent congenital pathology that is part of the spectrum of fibrocystic diseases, characterized mainly by malformation of bile ducts. These patients often have stones and ...cholangitis, which respond poorly to conventional endoscopic retrograde cholangiopancreatography. To date, there is little evidence on the usefulness of cholangioscopy in this disease, so we describe the experience of performing cholangioscopy in a patient with hepatolithiasis and Caroli disease.
Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without ...scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL).
This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count <50x109/L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded.
A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed.1-4 FFP and/or platelets were administered in 41 patients (7.6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4.8%) and in 33 out of 1,472 procedures (2.2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding.
The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion.
Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices.
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•Multicenter analysis of prophylactic administration of blood products in 536 outpatients with cirrhosis undergoing EBL.•The prophylactic transfusion protocol was only followed in 16% and 28% of procedures with high INR and/or low platelets, respectively.•Post EBL-bleeding occurred in 26 patients – 4.8% of patients and in 2.2% of procedures.•Patients that bled had higher Child-Pugh and MELD scores compared to those that did not bleed.•There was no clear relationship between post-EBL bleeding and the baseline INR/platelet count before the procedure.
Budd-Chiari syndrome is defined as the obstruction of the hepatic venous flow. In Colombia, there is limited evidence regarding the characterization of these patients. This study aims to describe the ...clinical features, management, and survival of these patients in a Colombian hepatology reference center. This study aimed to describe the clinical features, management, and survival of patients diagnosed with Budd-Chiari Syndrome at a Colombian Hospital from 2010 to 2021.
A retrospective descriptive longitudinal study of a cohort of patients with Budd-Chiari syndrome. Adult patients diagnosed with Budd-Chiari Syndrome were included. A descriptive analysis of the data was carried out.
A total of 31 patients diagnosed with Budd-Chiari syndrome were included. 58.1% (n=18) were women. The median age was 27 years interquartile range (IQR) 23-27. Ascites was the main clinical manifestation (87.1%, n=27). At the time diagnosis was made, 48.4% (n=15) were cirrhotic. Acquired thrombophilia was the main prothrombotic risk factor (48.4%, n=15), with the antiphospholipid syndrome as the most frequent cause (73.3%). The principal location of the outflow obstruction was in the hepatic veins (73.3%, n=22). 48.3% (n=14) had a Class II Rotterdam score (intermediate prognosis). 80.6% (n=25) were on anticoagulation. A transjugular intrahepatic portosystemic shunt (TIPS) was placed in 6 patients (19.4%), and five patients received liver transplants (16.1%). 25.8% (n=8) died. The median time from diagnosis to death was 337.1 days interquartile range (IQR) 46.5-647.5.
Budd-Chiari syndrome is an infrequent disease poorly described in Colombia. This study shows that this population has similar risk factors, clinical features, and mortality as it is described in other cohorts.
Introducción: Cerca del 10% al 15% de los pacientes con coledocolitiasis presentan cálculos gigantes definidos como aquellos que miden más de 10 mm a 15 mm. La extracción de estos puede ser ...problemática aún para endoscopistas experimentados. Casi todos los pacientes con esta patología pueden ser tratados endoscópicamente y la mayoría de los cálculos son removidos con la realización de esfinterotomía (EFT), litotripsia mecánica (LM) o dilatación papilar con balón grande (DPBG). La DPBG ha demostrado ser efectiva en el manejo del cálculo gigante y disminuye la necesidad de LM.Objetivos: Determinar la prevalencia de coledocolitiasis gigante en el Hospital Universitario de la Samaritana (HUS) entre el 2009 y el 2014, la frecuencia de éxito endoscópico y la necesidad de manejo quirúrgico, además de evaluar los factores asociados con el uso de litotripsia en casos de cálculos gigantes de la vía biliar. Materiales y Métodos: El presente es un estudio de casos y controles de pacientes con cálculos gigantes definidos como cálculos mayores de 10 mm en pacientes llevados a colangeopancreatografía retrógrada endoscópica (CPRE) en el HUS entre 2009 y 2014. Los casos fueron los pacientes a quienes se les realizó litotripsia y, los controles, quienes no requirieron este procedimiento. Los resultados se presentan como medias o medianas y se indican sus respectivas medidas de dispersión para las variables continuas, según pruebas de normalidad o como frecuencias y porcentajes para las variables categóricas. Se realizó un análisis de regresión logística con el principal objetivo de determinar los factores asociados con litotripsia, en el que se incluyeron las variables biológicamente plausibles o que, estadísticamente, mostraron diferencias en el análisis bivariado (p<0,200). Los resultados se presentan como odds ratios (oportunidad relativa) ajustados (ORA). Resultados: Entre 2009 y 2014 se realizaron un total de 1403 CPRE, de las cuales 198 (14.1%) tuvieron presencia de cálculos gigantes. Fue más frecuente la coledocolitiasis gigante en el sexo femenino que en el masculino. La edad promedio de los pacientes fue de 66,6 años. El diámetro promedio del colédoco fue de 18 mm, el diámetro promedio de los cálculos fue de 18 mm. Al 99% de los pacientes se les realizo EFT, el 28% requirió LM, al 48% se les realizo DPBG, el 5,5% requirieron LM y DPBG y el 30.8% requirió el avance de protesis biliar y más de una CPRE para la resolución de la coledocolitiasis. En el 89.9% de los casos, el manejo endoscópico fue exitoso. El 10.1% requirió cirugía. En el 9,0% de los casos se presentaron complicaciones (6 pancreatitis, 7 sangrados, 2 impactaciones de canastilla y 1 perforación). En el análisis bivariado, la DPBG fue un factor protector del requerimiento de LM (ORA 0,07-IC 95% 0,025-0,194) y el tamaño del colédoco es un predictor del requerimiento de LM (p< 0,05)Conclusiones: En nuestra serie, la prevalencia coledocolitiasis gigante y el éxito del manejo endoscópico es similar a la reportada en la literatura. La EFT, LM y DPBG fueron efectivas en el manejo de los cálculos gigantes. El tamaño del colédoco es un predictor de requerimiento de LM y la DPBG disminuyó el requerimiento de LM.
Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of ...limited availability in primary health care centers.
Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites.
Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³).
Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27.
The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.
Fístula biliopleurobronquial: reporte de un caso Galindo Orrego, Pablo; Bejarano Rengifo, Janeth; Labrador López, Christian ...
Revista de gastroenterología del Perú,
10/2017, Letnik:
37, Številka:
4
Journal Article
Odprti dostop
La fístula biliopleurobronquial (FBB) es una comunicación anormal entre la vía biliar y el árbol bronquial. Es una condición infrecuente, generalmente secundaria a un proceso infeccioso local o a un ...evento traumático. La bilioptisis es patognomónica. Presentamos el caso de una mujer de 37 años con historia de cirrosis biliar secundaria, en lista para trasplante hepático, con múltiples episodios de colangitis previos y usuaria de derivación biliar externa, quien curso con bilioptisis y mediante gammagrafía HIDA con SPECT se confirmó fistula biliopleurobronquial. Éste caso se resolvió con derivación percutánea de la vía biliar
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