Complex endoscopic management of gallbladder cancer patient with Bouveret syndrome.
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ABSTRACT:
SUBMITTER: Vanek P
PROVIDER: S-EPMC7805016 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.
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Project description:Given the ubiquity of laparoscopic cholecystectomy in the modern era, the incidence of incidentally diagnosed gallbladder cancers (GBCs) is rising. This unique clinical scenario poses specific challenges regarding the role of staging, re-resection, and adjuvant treatment for patients with this disease. This review will address these controversies with the latest published data.
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| S-EPMC6895734 | biostudies-literature
Project description:ObjectivesEndoscopic transpapillary gallbladder drainage (ETGBD) has been proposed as an alternative to surgery or percutaneous cholecystostomy in patients with acute calculus cholecystitis (ACC). We aimed to evaluate the safety and efficacy of ETGBD via endoscopic transpapillary gallbladder stenting (ETGBS) or endoscopic naso-gallbladder drainage (ENGBD) as either a bridging or a definitive treatment option for patients with ACC when a cholecystectomy is delayed or cannot be performed.MethodsFrom July 2014 to December 2018, 171 patients with ACC in whom ETGBD were attempted were retrospectively reviewed. The technical and clinical success rates and adverse events were evaluated. Moreover, the predictive factors for technical success and the stent patency in the ETGBS group with high surgical risk were examined.ResultsThe technical and clinical success rates by intention-to-treat analysis for ETGBD were 90.6% (155/171) and 90.1% (154/171), respectively. Visible cystic duct on cholangiography were significant technical success predictor (adjusted odds ratio: 7.099, 95% confidence interval: 1.983-25.407, P = 0.003) as per logistic regression analysis. Adverse events occurred in 12.2% of patients (21/171: mild pancreatitis, n = 9; acute cholangitis, n = 6; post-endoscopic sphincterotomy bleeding, n = 4; and stent migration, n = 1; ACC recurrence, n = 1), but all patients were treated with conservative management and endoscopic treatment. Among the ETGBS group, the median stent patency in 70 patients with high surgical risk was 503 days (interquartile range: 404.25-775 days).ConclusionsETGBD, using either ETGBS or ENGBD, may be a suitable bridging option for ACC patients unfit for urgent cholecystectomy. In high surgical risk patients, ETGBS may be a promising and useful treatment modality with low ACC recurrence.
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Project description:According to the recently updated Tokyo Guidelines, laparoscopic cholecystectomy still represents the gold standard for the treatment of acute cholecystitis. However, fragile patients, due to comorbidities or poor clinical conditions, have a high surgical risk. In such cases, percutaneous or endoscopic gallbladder drainage is considered the treatment of choice. In particular, endoscopic ultrasound-guided gallbladder drainage with the placement of specifically designed stents is now considered an alternative option. In addition, the opening of an access door to the lumen of the gallbladder could offer new opportunities for the endoscopic treatment of gallbladder diseases. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the endoscopic ultrasound-guided gallbladder drainage.
| S-EPMC7237126 | biostudies-literature
Project description:Bouveret's syndrome is a complication of cholelithiasis that presents with gastric outlet obstruction due to an impacted gallstone in the duodenum following cholecystoduodenal fistula. This is a rare presentation of biliary-enteric fistula; therefore, there are no standardized guidelines for the management of this disease. We present a case of a patient with Bouveret's syndrome managed with laparoscopic surgery after an unsuccessful attempt of endoscopic removal.
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Project description:Gallbladder cancer (GBC) is infrequent but most lethal biliary tract malignancy characterized by an advanced stage diagnosis and poor survival rates attributed to absence of specific symptoms and effective treatment options. These necessitate development of early prognostic/predictive markers and novel therapeutic interventions. MicroRNAs (miRNAs) are small, non-coding RNA molecules that play a key role in tumor biology by functioning like tumor suppressor- or onco- genes and their aberrant expression are associated with the pathogenesis of several neoplasms with overwhelming clinical implications. Since miRNA signature is tissue specific, here, we focused on current data concerning the miRNAs aberrations in GBC pathogenesis. In GBC, miRNAs with tumor suppressor activity (miR-135-5p, miR-335, miR-34a, miR-26a, miR-146b-5p, Mir-218-5p, miR-1, miR-145, mir-130a) were found downregulated, while those with oncogenic property (miR-20a, miR-182, mir-155) were upregulated. The expression profile of miRNAs was significantly associated with GBC prognosis and prediction, and forced over-expression/ inhibition of these miRNAs was shown to affect tumor growth and development. Further, differential expression of miRNAs in the blood samples of GBC patients suggest miRNAs as promising noninvasive biomarker. Thus, miRNAs represent potential candidate for GBC management, though many hurdles need to be overcome before miRNAs therapy can be clinically applied to GBC prevention and treatment.
| S-EPMC4724610 | biostudies-literature
Project description:The aim of this study was to review the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing gallbladder (GB)-protruded lesions. Thirty-eight patients underwent CH-EUS for the diagnosis of GB-protruded lesions. Twenty-four patients whose major axes of their largest lesions were longer than 10 mm were recruited. The ability of CH-EUS to diagnose malignant or benign lesions was reviewed. We treated lesions with brindled enhanced patterns as malignant and those with uniformly enhanced or unenhanced patterns as benign. Furthermore, three gastroenterologists who were not familiar with pancreaticobiliary EUS compared the diagnostic abilities of CH-EUS and conventional EUS using photographs. The sensitivity, specificity, and malignant accuracy of CH-EUS were 100, 94.4, and 95.8%, respectively. The number of lesions that presented with enhanced patterns was significantly different between the malignant lesions and the benign lesions (P < 0.001). In the comparison of diagnostic abilities between CH-EUS and conventional EUS by the three gastroenterologists, CH-EUS was significantly superior to conventional EUS in terms of sensitivity, specificity, and accuracy (76.1 vs. 42.9%, P = 0.029; 66.7 vs. 39.2%, P = 0.005; and 69.4 vs. 40.3%, P < 0.001; respectively). In conclusion, CH-EUS was useful for diagnosing malignant and benign GB-protruded lesions.
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Project description:Video 1A purely endoscopic management approach for Type V Mirizzi syndrome.
| S-EPMC8351458 | biostudies-literature
Project description:BACKGROUND: The aim of this retrospective study was to review all patients diagnosed with gallbladder cancer over a 10-year period to assess variables affecting survival. METHODS: Patients diagnosed with gallbladder cancer from January 1990 to December 1999 were identified from the Lothian Surgical Audit database and a case-note review was performed. RESULTS: The 44 patients who were studied (33 women, 11 men) had a mean age of 66 years (range 42-90 years). The diagnosis was established preoperatively in 25 patients (57%), intraoperatively in 5 patients (11%) and incidentally following pathological examination of cholecystectomy specimens in 14 patients (32%). None of the 25 patients diagnosed preoperatively underwent curative operations (median survival 4 months). All five patients diagnosed at the time of attempted cholecystectomy had advanced irresectable disease (median survival 1 month). The overall median survival in 14 patients with an incidental diagnosis of gallbladder cancer was 16 months; however, in eight of these patients who were considered to have had a potentially curative resection, the median survival was 38 months. DISCUSSION: The prognosis for patients diagnosed preoperatively or at the time of cholecystectomy is very poor. Patients with an incidental finding of gallbladder cancer have a significantly better prognosis and should be considered for further radical re-resection.
| S-EPMC2020581 | biostudies-other