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Surg Endosc 2021 Jun 8. Epub 2021 Jun 8.

Department of Gastroenterology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar-Ilan University, Safed, Israel.

Background: Choledocholithiasis is a commonly encountered disease that is associated with various clinical presentations ranging from mild form of biliary colic to severe life-threatening acute cholangitis. Recently, peri-ampullary diverticulum (PAD) has been linked to the development of biliary diseases; however, data regarding its association with the development of acute cholangitis in the setting of choledocholithiasis are scarce.

Aims: We aimed to identify predictors, specifically PAD, for the development of acute cholangitis in patients with choledocholithiasis. Read More

Clin J Gastroenterol 2021 Jun 7. Epub 2021 Jun 7.

Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.

Endoscopic stone removal is currently the first-line procedure for the treatment of common bile duct stones. Advances in equipment and treatment techniques have expanded the scope of application of endoscopic treatment to include stones that have previously been difficult to remove endoscopically, such as stacked stones and large stones. For the treatment of common bile duct stones in elderly patients in particular, long-term placement of a biliary stent is increasingly being selected. Read More

Lab Med 2021 Jun 4. Epub 2021 Jun 4.

Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona,  Switzerland.

Objective: The likelihood of common bile duct (CBD) stones considers liver blood tests (LBTs) if they are markedly altered only. The aim of our study was to find a reliable tool based on LBTs to predict the presence of CBD stones.

Methods: We retrospectively considered all patients who underwent magnetic resonance cholangiopancreatography (MRCP) because of suspected CBD stones from January 2014 to June 2019. Read More

Surg Endosc 2021 Jun 2. Epub 2021 Jun 2.

University Hospital Monklands, Airdrie, Scotland, ML6 0JS, UK.

Background: Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients' quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE.

Methods: A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Read More

Radiology 2021 Jun 1:210890. Epub 2021 Jun 1.

From the Departments of Radiology and Student Affairs, University of Arizona College of Medicine Phoenix, 435 N 5th St, HSEB C536, Phoenix, AZ 85004 (E.v.), and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (P.R.M.).

J Pak Med Assoc 2021 Mar;71(3):929-932

Department of Medicine. The Aga Khan University Hospital, Karachi.

Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital.

Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Read More

Ann Hepatobiliary Pancreat Surg 2021 May;25(2):259-264

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Despite development in endoscopic treatment and minimally invasive surgery for choledocholithiasis, there remains a small number of patients who require bypass Roux-en-Y choledochojejunostomy (RYCJ) because of the intractable occurrence of common bile duct (CBD) stones. We herein present the detailed procedures of open RYCJ customized for intractable choledocholithiasis. The first method is a side-to-end choledochojejunostomy with intraluminal closure of the distal CBD. Read More

J Laparoendosc Adv Surg Tech A 2021 May 27. Epub 2021 May 27.

DAICIM Foundation, Buenos Aires, Argentina.

Korean J Gastroenterol 2021 May;77(5):253-257

Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.

Cannulation of the portal vein is a rare complication of ERCP. This paper reports a case of portal vein catheterization during ERCP in a patient with choledocholithiasis. A 62-year-old man was admitted to the Presbyterian Medical Center with right upper quadrant pain and jaundice. Read More

Obes Surg 2021 May 25. Epub 2021 May 25.

Department of Surgery, Barmherzige Schwestern Krankenhaus Wien, Stumpergasse 13, 1060, Vienna, Austria.

Gallstone disease after bariatric surgery is a common condition due to the obesity and rapid weight loss. Because of increasing obesity amongst the population, and the gastric bypass having been established as the standard treatment for morbid obesity, the occurrence of bile duct stones after this kind of surgery remains a therapeutic dilemma. We present a case of obstructed choledocholithiasis with shrinking of the gallbladder and consequent cholangitis in a 69-year-old Caucasian male patient after a laparoscopic Roux-and-Y gastric bypass (LRYGB), who underwent a successful laparoscopic single-stage bile stone removal of the choledochal duct using intraoperative ultrasound and choledochoscopy. Read More

Vet Clin Pathol 2021 May 24. Epub 2021 May 24.

Department of Disease Diagnosis, Therapy, Obstetrics, and Animal Reproduction, Moscow State Academy of Veterinary Medicine and Biotechnology - MVA by K. I. Skryabin, Moscow, Russian Federation.

Background: Hepatic cholesterol accumulation in small breed dogs is a leading risk factor for hepatic fatty changes, gallbladder hypomotility, and cholelith development, which, if not discovered early, could lead to life-threatening choledocholithiasis and acute pancreatitis.

Objective: This study proposed to assess the use of hepatocyte-derived canine familiaris (cfa)-microRNAs (miRNA-122, -34a, and -21) as new diagnostic serum biomarkers of liver steatosis or fibrosis, for which both processes have been implicated in canine cholecystolithiasis.

Methods: Forty client-owned dogs diagnosed with cholecystolithiasis and hepatic steatosis (C+HS) or fibrosis (C+HF) based on ultrasonographic, biochemical, and histopathologic findings, and 20 healthy dogs used as controls were included in the study. Read More

VideoGIE 2021 May 27;6(5):231-233. Epub 2021 Feb 27.

Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.

Video 1ERCP was notable for a proximally migrated biliary stent. Cholangiogram demonstrated multiple filling defects consistent with choledocholithiasis surrounding the proximally migrated biliary stent. Retrieval of the stent was successful using cholangioscopy-directed electrohydraulic lithotripsy, extracorporeal shockwave lithotripsy, mechanical lithotripsy, and minisnare over the course of 2 ERCPs. Read More

Can Assoc Radiol J 2021 May 24:8465371211013786. Epub 2021 May 24.

Department of Radiology, 3710McMaster University, Juravinski Hospital, Hamilton, Ontario, Canada.

Purpose: To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease.

Methods: A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. Read More

J Laparoendosc Adv Surg Tech A 2021 May 20. Epub 2021 May 20.

Department of Hepatopancreatobiliary Surgery, Changzhou First People's Hospital, Third Affiliated Hospital of Soochow University, Changzhou, China.

To compare the effectiveness and safety of continuous suture and interrupted suture in Laparoscopic Common Bile Duct Exploration (LCBDE) for choledocholithiasis. The data of 125 patients with choledocholithiasis treated with LCBDE in our department from January 2017 to January 2019 were retrospectively collected and divided into two subgroups: the continuous suture group ( = 56) and the interrupted suture group ( = 69). The operation duration, time to suture, intraoperative blood loss, extubation time, hospital stay, total hospitalization expenses, preoperative and postoperative diameters of the common bile duct (CBD), and the occurrence rate of postoperative complications were all compared between the two groups. Read More

Mayo Clin Proc Innov Qual Outcomes 2021 Apr 8;5(2):377-387. Epub 2021 Apr 8.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups.

Patients And Methods: We conducted a retrospective analysis of 257 consecutive hospitalized adult patients with acute cholangitis due to endoscopic retrograde cholangiopancreatography-confirmed choledocholithiasis between January 1, 2015, and December 31, 2019. Patients were divided into 3 age groups: less than 65 years, 65 to 79 years, and 80 years or older. Read More

JMA J 2021 Apr 2;4(2):176-177. Epub 2021 Apr 2.

Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.

Front Cell Infect Microbiol 2021 29;11:625589. Epub 2021 Apr 29.

Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.

Background: The pathogenesis of choledocholithiasis is closely related to the role of bacteria. However, little is known about the predictive role of bile bacteria in clinical conditions of patients and the compositional and functional characteristics of biliary microbiota in choledocholithiasis.

Methods: To investigate the predictive value of biliary bacteria, clinical data of 488 patients with choledocholithiasis were collected. Read More

Int J Surg Case Rep 2021 May 29;82:105927. Epub 2021 Apr 29.

Department of General Surgery, Mata Chanan Devi Hospital, New Delhi, India.

Introduction: Horseshoe kidneys are the most common fusion defect of the kidneys, which amounts to about 0.25% of the population. They are usually asymptomatic and are often identified incidentally. Read More

World J Hepatol 2021 Apr;13(4):456-471

Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.

Background: Acute cholangitis (AC) is a disease spectrum with varying extent of severity. Age ≥ 75 years forms part of the criteria for moderate (Grade II) severity in both the Tokyo Guidelines (TG13 and TG18). Aging is associated with reduced physiological reserves, frailty, and sarcopenia. Read More

Clin Endosc 2021 May 4. Epub 2021 May 4.

Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. Read More

J Surg Case Rep 2021 Apr 27;2021(4):rjab144. Epub 2021 Apr 27.

Department of General Surgery, Ospedale San Biagio, ASL VCO, Domodossola, Italy.

We present the case of choledocholithiasis with purulent cholangitis treated with laparoscopic approach in a patient with Roux-en-Y reconstruction after total gastrectomy. After cholangiography, the common bile duct was explored with trans-cystic choledochoscopy and the retained stone extracted under direct vision. Read More

J Laparoendosc Adv Surg Tech A 2021 May 3. Epub 2021 May 3.

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Both endoscopic nasobiliary drainage (ENBD) and a plastic stent placement have some limitations in biliary decompression of elderly patients with acute cholangitis of severe type (ACST) due to choledocholithiasis. Dual stent placement may improve bile drainage without obvious discomfort. Here, we evaluated its advantages in the biliary decompression of elderly patients with ACST. Read More

Surg Open Sci 2021 Jan 15;3:8-15. Epub 2020 Aug 15.

Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland.

Background: Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete.

Methods: An International Prospective Register of Systematic Reviews-registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy "intraoperative AND cholangiogra* AND cholecystectomy." Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. Read More

J Laparoendosc Adv Surg Tech A 2021 Apr 28. Epub 2021 Apr 28.

Division of Surgery, Northern Health, Epping, Australia.

Common bile duct exploration (CBDE) is performed uncommonly. Issues surrounding its uptake in the laparoscopic era include perceived difficulty and lack of training. We aim to determine the success of CBDE performed by "specialist" and "nonspecialist" common bile duct (CBD) surgeons to determine whether there is a substantial difference in success and safety. Read More

Gastrointest Endosc 2021 Apr 24. Epub 2021 Apr 24.

Keck School of Medicine, University of Southern California, Los Angeles, California; College of Medicine, University of Florida, Gainsville, Florida; University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Background And Aims: Despite improvements in imaging and laboratory medicine, consensus criteria for the diagnosis of cholangitis are lacking. Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment for cholangitis, it should be reserved for those patients with a high probability of the diagnosis, given the morbidity associated with the procedure.

Methods: A comprehensive literature search of PubMed (coverage 1898-present), Web of Science (1900-July 15, 2019), Embase (1943-July 15, 2019), and the Cochrane library (1898-July 15, 2019) was performed to identify studies that reported on diagnostic paradigms and individual diagnostic parameters of cholangitis. Read More

Pol Merkur Lekarski 2021 Apr;49(290):108-113

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.

Aim: The aim of this study was to evaluate the efficacy of determining the microRNA-122 and microRNA-21 expression levels in serum and bile as predictors of the presence of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis.

Materials And Methods: The study included 32 patients who were divided into two groups: I - study group and II - comparison group. The study group included patients with acute calculous cholecystitis (ACC) and oligosymptomatic choledocholithiasis (OCL) (n=23), and the comparison group consisted of patients with ACC without choledocholithiasis (n=9). Read More

Int J Surg Case Rep 2021 Apr 23;81:105794. Epub 2021 Mar 23.

Department of Surgery and Science, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan. Electronic address:

Introduction And Importance: An intramural cyst is a rare lesion that develops in the wall of the gallbladder. Although the acquired cysts originate from the Rokitansky-Aschoff sinus (RAS), the congenital them, such as the duct of Luschka, are rare. Luschka's duct is a unique and specific tissue component that is histologically different from the inherent bile duct and without the communication to the lumen of the gallbladder. Read More

Int J Surg Case Rep 2021 Apr 26;81:105837. Epub 2021 Mar 26.

Department of General and Emergency Surgery, Policlinico G. Martino, University of Messina, Italy.

Introduction: Choledocholithiasis in Roux-en-Y patients is a therapeutic challenge for both surgeons and endoscopists. In fact, typical procedures, such as ERCP, can't be performed due to the altered anatomy of the patient. Nowadays, procedures on this kind of patient are performed not only in specialized bariatric centers, but, due to the increasing number of patients undergoing bariatric surgery, are starting to become more common even in smaller and non-specialized centers that don't possess the same expertise and technology. Read More

Endoscopy 2021 05 22;53(5):559. Epub 2021 Apr 22.

Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.

Surg Laparosc Endosc Percutan Tech 2021 Apr 21. Epub 2021 Apr 21.

Division of Surgery Office of Research, Northern Health Department of Surgery, University of Melbourne, Epping Department of Surgery, Western Health, Footscray Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Vic., Australia.

Background: Laparoscopic common bile duct exploration (LCBDE) can be performed to treat choledocholithiasis at the time of laparoscopic cholecystectomy. The aim of this study was to identify factors that predict the success of LCBDE.

Materials And Methods: A retrospective audit was performed on patients who underwent LCBDE for the management of choledocholithiasis at Northern Health between 2008 and 2018. Read More