Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis.
CONCLUSIONS: There is a trend towards more mortality from early ERCP with or without sphincterotomy in the setting of acute gallstone pancreatitis without cholangitis. However, more studies are needed. In the meantime, early ERCP should not be carried out unless there is at least a slight suspicion of cholangitis or persistent ampullary obstruction.
PMID: 19454823 [PubMed - in process] (Source: JOP)...
POSTED 06/27/2009 at 12:14 PM --
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Proinflammatory cytokines in alcohol or gallstone induced acute pancreatitis. A prospective study.
CONCLUSION: The present study confirms previous findings and supports the hypothesis that, except for IL-8, the biochemical profile and clinical outcome is independent of the underlying etiology. Revealing the complex spatial and temporal profile of proinflammatory cytokine expression in acute pancreatitis is necessary and important for the development of a more targeted rational therapy.
PMID: 19454816 [PubMed - in process] (Source: JOP)...
POSTED 06/27/2009 at 12:14 PM --
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Right Porto-Ovarian H-Shunt for the Surgical Treatment of Symptomatic Portal Biliopathy: A Case Report and Literature Review
Portal hypertension, especially when it is caused by extrahepatic portal vein thrombosis, is commonly followed by the development of an abnormal periportal and pericholedochal variceal network, which form a portal cavernoma. This may exert extrinsic pressure on the adjacent biliary ducts and gallblader, causing morphologic abnormalities, termed portal biliopathy, which is usually leading to asymptomatic cholestasis, while less frequently it can be associated with obstructive jaundice, gallstone formation, and cholangitis. Endoscopic stone extraction can effectively treat portal biliopathy when cholangitis is associated with common bile duct stones. Portosystemic shunts are indicated in cases of disease recurrence as they can achieve regression of portal cavernoma and usually relieve sympto......
POSTED 06/25/2009 at 09:39 AM --
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Needlescopic versus laparoscopic cholecystectomy: a meta-analysis
Conclusion: NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post-operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate. (Source: ANZ Journal of Surgery)...
POSTED 06/24/2009 at 06:00 PM --
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Med Sci Monit 2009; 15(7):RA147-156 "Acute pancreatitis: A literature review"
Acute pancreatitis (AP) is an inflammatory disease characterized by steady, acute abdominal pain of varying severity, often radiating from the epigastrium to the back. Its presentation ranges from a self-limiting mild disorder to a more severe and fulminant disease. Severe acute pancreatitis accounts for 30% of all deaths related to pancreatitis. The incidence of AP is increasing progressively with a corresponding increase in the incidence of its risk factors. Alcohol abuse and gallstone migration are the established risk factors for development of AP. In recent years, genetic factors and obesity have also been identified as risk factors responsible for the development of AP. The pathophysiology of AP involves acute inflammation of the acinar cells. Excessive acinar cell injury leads to a ......
POSTED 06/23/2009 at 08:45 AM --
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Biliary Colic Preceding Acute Gallstone Pancreatitis
Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s11605-009-0949-9Authors
Alejandro Oría, Av Alvear 1583, 1014 Capital Buenos Aires ArgentinaGustavo Kohan, University of Buenos Aires Department of Surgery, Cosme Argerich Hospital Buenos Aires Argentina
Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Surgery)...
POSTED 06/23/2009 at 01:06 AM --
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Biliary Colic is a Valuable Clinical Descriptor for Biliary Pain Due to “Uncomplicated” Gallstone Disease
Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s11605-009-0950-3Authors
Marc G. H. Besselink, University Medical Center Utrecht Utrecht The NetherlandsKarel J. van Erpecum, University Medical Center Utrecht Utrecht The Netherlands
Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Surgery)...
POSTED 06/23/2009 at 01:06 AM --
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Lanreotide for the treatment of acromegaly.
Authors: Castinetti F, Saveanu A, Morange I, Brue T
Lanreotide is an eight-amino acid peptide, which is an analog of the native somatostatin peptide, physiological inhibitor of growth hormone (GH). The drug shows high binding affinity for somatostatin receptors, SSTR2 and SSTR5, which is the primary mechanism considered to be responsible for decreasing GH secretion and GH cell proliferation in acromegaly. Two different formulations of lanreotide are currently available: lanreotide slow release, which requires intramuscular injection every 7-14 days, and lanreotide autogel, which requires deep subcutaneous injection every 4-8 weeks. Several studies have been published to date on the use of lanreotide in acromegaly. Antisecretory efficacy has been reported in 35%-70% of cases; this huge ......
POSTED 06/15/2009 at 06:00 PM --
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Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral
This study assessed whether these guidelines are feasible and cost-effective.Admissions for gallstone pancreatitis between January 2006 and January 2008 were reviewed. Readmissions for subsequent pancreatitis or biliary pathology were noted together with additional investigations, severity scores, hospital stay and time to cholecystectomy. The costs of readmission and theoretical costs of developing a dedicated operating list were provided by independent accountants.During the 2 years, 153 patients were admitted. Twenty-one patients (13·7 per cent) had further attacks requiring 40 readmissions. There were no deaths. Additional hospital costs related to readmissions were £172 170, including bed occupancy (£67 860), investigations (£12 510) and 153 cholecystectomies on an existing theatr......
POSTED 06/14/2009 at 06:00 PM --
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Cholecystocolonic fistula prevents upper intestinal obstruction by a large gallstone after perforation into the duodenum
Discussion This cholecystocolonic fistula provoked a short bowel syndrome with symptomatic diarrhea and prevented an upper gastrointestinal
ileus caused by the large perforated gallstone into the duodenum. This interesting constellation has not been described in
literature yet.
Content Type Journal ArticleCategory Case Management and Clinical ConsequencesDOI 10.1007/s00423-009-0517-5Authors
Stephan Engelberger, University of the Saarland Department of General, Visceral, Vascular and Pediatric Surgery 66421 Homburg/Saar GermanyJochen Schuld, University of the Saarland Department of General, Visceral, Vascular and Pediatric Surgery 66421 Homburg/Saar GermanyMartin K. Schilling, University of the Saarland Department of General, Visceral, Vascular and Pediatric Surgery 66......
POSTED 06/13/2009 at 03:38 AM --
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[Lipids and Lipoproteins: Metabolism, Regulation, and Signaling] Decreased Expression of Cholesterol 7{alpha}-Hydroxylase and Altered Bile Acid Metabolism in Apobec-1-/- Mice Lead to Increased Gallstone Susceptibility
Quantitative trait mapping in mice identified a susceptibility locus for gallstones (Lith6) spanning the Apobec-1 locus, the structural gene encoding the RNA-specific cytidine deaminase responsible for production of apolipoprotein B48 in mammalian small intestine and rodent liver. This observation prompted us to compare dietary gallstone susceptibility in Apobec-1–/– mice and congenic C57BL/6 wild type controls. When fed a lithogenic diet (LD) for 2 weeks, 90% Apobec-1–/– mice developed solid gallstones in comparison with 16% wild type controls. LD-fed Apobec-1–/– mice demonstrated increased biliary cholesterol secretion as well as increased cholesterol saturation and bile acid hydrophobicity indices. These changes occurred despite a relative decrease in......
POSTED 06/11/2009 at 06:00 PM --
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Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome)
We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques. (Source: Diagnostic and Therapeutic Endoscopy)...
POSTED 06/09/2009 at 06:02 PM --
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Natural Progression of Biochemical Markers of Biliary Tract Obstruction in Patients with Gallstone Pancreatitis
The presenting pattern and natural progression of biochemical markers of biliary tract obstruction in patients with gallstone pancreatitis have not been elucidated. We analyzed serial values of bilirubin levels following admission to discharge in 143 patients. Ninety-four of patients demonstrated a Decrescendo (falling) pattern of bilirubin levels from admission until normalization at 21 hours (median). Forty-nine patients demonstrated a Crescendo-Decrescendo (initially rising) pattern with peak levels of bilirubin occurring at 39 hours after admission followed by a subsequent normalization after a median of 119 hours. Patients in the Decrescendo group were significantly younger (33 versus 41 years, P=.02) and more patients had experienced symptoms for greater than 48 hours (65% versus......
POSTED 06/09/2009 at 12:24 PM --
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Bouveret's Syndrome: Case Report and Review of the Literature
We describe a case of Bouveret's Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition. (Source: Gastroenterology Research and Practice)...
POSTED 06/09/2009 at 12:24 PM --
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Having Gallstones is the Greatest Risk Factor for Gallbladder Cancer
Did you know that the most common and greatest risk factors for developing gallbaldder cancer is having gallstones? Gallstones are deposits of calcium or cholesterol that settle in the gallbladder... (Source: About.com Cancer)...
POSTED 06/06/2009 at 07:26 PM --
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Mandatory and optional function tests for biliary disorders
Function tests in gastroenterology and hepatology aim to provide criteria for diagnosis of specific disorders and for prediction of patient responses to therapy. This review focuses on the utility of function tests in the management of gallstone disease and functional biliary disorders. In gallstone disease, function tests may be considered in the selection of candidates for nonsurgical therapy of gallbladder stones only. In cases of suspected functional biliary disorders, experts have advocated the use of classical noninvasive tests such as hepatobiliary scintigraphy. However, unequivocal evidence for their utility in diagnosis or patient selection for invasive treatment is yet to be provided. Recently, more advanced noninvasive tests such as real-time ultrasonography or secretin-stimulat......
POSTED 05/31/2009 at 11:00 PM --
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[Natural course and treatment strategy of gallbladder polyp.]
Authors: Bang S
The polypoid lesions of gallbladder have explosively increased with enhanced feasibility of transabdominal ultrasonography. Most of small polyps less than 10 mm are benign and remain static for a long period. In small polyps, three to six month intervaled ultrasonography is warranted in the initial follow-up, but the duration of follow-up period is not clarified. The polypoid lesions larger than 10 mm show a quite different feature. They showed a remarkable risk of malignancy (34-88%) and should be treated by surgery. Furthermore, age more than 50 years and combined gallstone are important factors predicting malignancy in polypoid lesions of gallbladder. In addition, other factors including solitary polyp and the presence of symptoms are considered as risk factors. Lapa......
POSTED 05/31/2009 at 06:00 PM --
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Perioperative management of cholelithiasis in patients presenting for laparoscopic Roux-en-Y gastric bypass: have we reached a consensus?
Authors: Patel JA, Patel NA, Piper GL, Smith DE, Malhotra G, Colella JJ
Obesity and rapid weight loss after bariatric surgery is associated with, the development of cholelithiasis and related complications. Several algorithms have been suggested in the management of the asymptomatic gallstones in patients presenting for weight loss surgery (WLS). Charts of patients presenting for laparoscopic Roux-en-Y (LRYGB) were retrospectively reviewed. Concomitant or delayed cholecystectomies were performed for symptomatic disease at the time of or after LRYGB, respectively. A total of 1376 patients underwent LRYGB and 21.0 per cent had a history of a cholecystectomy. An additional 2.7 per cent underwent cholecystectomy. The remaining 1050 "at-risk" patients were followed for a mean of 32.3 months......
POSTED 05/31/2009 at 06:00 PM --
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New Hybrid Approach for NOTES Transvaginal Cholecystectomy: Preliminary Clinical Experience.
Conclusion. Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.
PMID: 19546124 [PubMed - in process] (Source: Surgical Innovation)...
POSTED 05/31/2009 at 06:00 PM --
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Bouveret's Syndrome - Case Report.
We report on an 80-year-old woman without previous episodes of biliary colic, and known cholecystolithiasis who underwent emergency surgery due to pyloric obstruction caused by a large, 7-cm stone, after failure of endoscopic treatment. The stone was removed through pylorotomy, which was closed transversely in multiple layers and patched with omentum. The patient's postoperative course was complicated by operative wound infection. She was discharged on postoperative day 22 and had no complaints at the 6-month follow-up.
PMID: 19536722 [PubMed - as supplied by publisher] (Source: Zentralblatt fur Chirurgie)...
POSTED 05/31/2009 at 06:00 PM --
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