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Endoscopic diagnosis and treatment of biliary complications after laparoscopic cholecystectomy


Authors: B. Kianička 1;  P. Dítě 2;  I. Suškevič 3
Authors‘ workplace: Gastroenterologické oddělení FN u sv. Anny Brno, přednosta prim. MUDr. Bohuslav Kianička, Ph. D. 1;  Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. 2;  Klinika zobrazovacích metod Lékařské fakulty MU a FN u sv. Anny Brno, přednosta doc. MUDr. Petr Krupa, CSc. 3
Published in: Vnitř Lék 2007; 53(11): 1182-1189
Category: Original Contributions

Overview

Objective of study:
The main parameters studied in this retrospective study were the success of diagnoses carried out using endoscopic retrograde cholangiopancreatography (ERCP), the ability of ERCP to precisely determine the cause of complications and the effectiveness and morbidity of therapeutic ERCP.

Materials and method:
the study covers a period of 7 years (January 1997 – December 2003). The study retrospectively reviewed the histories of 92 patients who underwent laparoscopic cholecystectomy (LCE) and subsequently developed symptoms suggesting possible biliary complications (BC) from previous LCE, and indicating the performance of ERCP.

Results:
diagnostic ERCP was successful for all 92 patients (i.e. in 100% of cases). In 5 patients the ERCP found normal conditions. In the remaining 87 patients, the ERCP found pathological conditions corresponding to some form of biliary complication. Choledocholithiasis was detected in 59 patients, bile leakage from the cystic duct stump was found in 11 patients, bile leakage from the extrahepatic bile duct was found in 4 patients, biliary stenosis in the common hepatic duct was found in 5 cases and 8 patients had blockages of the extrahepatic bile duct. 10 patients out of 87 received only diagnostic ERCP and all 10 underwent surgery immediately following diagnosis. 77 out of 87 patients with established BC underwent endoscopic therapy after diagnostic ERCP. Therapeutic ERCP was entirely successful for 73 patients out of 87 with BC after LCE (83.92%), and did not require other modalities of treatment such as surgical or transhepatic procedures.

Conclusions:
In our sample the success rate for therapeutic ERCP was 83.92%. Morbidity relating to therapeutic ERCP was 3.9%. ERCP was shown to be highly effective in both diagnosing and treating BC after LCE.

Key words:
ERCP – laparoscopic cholecystectomy – biliary compliations – endoscopic therapy


Sources

1. Král V, Procházka V, Kocher M et al. Dnešní možnosti nápravy poranění žlučových cest. Rozhl Chir 1996; 75: 180-184.

2. Prat F, Pelletiere G, Ponchon T et al.What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy? Endoscopy 1997; 29: 341-348.

3. Gollan JL et al. National institutes of health consensus development conference statement on gallstones of laparoscopic cholecystectomy. Am J Surg 1993; 165: 390-396.

4. Soper NJ, Stockmann PT, Dunnegan DL et al. Laparoscopic cholecystectomy - the new gold standard? Arch Surg 1992; 127: 917-923.

5. Gurlich R, Maruna P, Lindner J et al. Hodnocení laparoskopické a laparotomické cholecystektomie srovnáním dynamiky proteinů akutní fáze. Rozhl Chir 1994; 73: 214-217.

6. Satinský I, Posolda T. Laparoskopická cholecystektomie v České republice: národní studie. Rohl Chir 1995; 74: 180-184.

7. Šváb J, Pešková M. Iatrogenní poškození žlučovodů při laparoskopické cholecystektomii. Rozhl Chir 1996; 75: 41-46.

8. Gurlich R, Sixta B, Oliverius M. Plánované laparoskopické výkony v klinické praxi. Čas Lék Čes 2006; 145: 195-200.

9. Novotný I. Endoskopická sonografie v diagnostice časné chronické pankreatitidy. Vnitř Lék 2000; 10: 704-708.

10. Novotný I, Lata J. Chronická pankreatitida v EUS obraze - rozbor nově diagnostikovaných případů v průběhu 38 měsíců. Bratislavské lekárske listy 2000; 12: 649-653.

11. Bret MP, Reinhold C. Magnetic resonance cholangiopankreatography. Endoscopy 1997; 29: 472-486.

12. Novotný I. Intraduktální sonografie žlučových cest v diferenciální diagnostice nejasných stenóz extrahepatálních žlučovodů. Čes Slov Gastroent a Hepatol 2006; 2: 97-102.

13. Prat F, Amougal G, Pelletier G et al. Prospective controlled study of endoscopic ultrasonography in patients with suspected common bile duct lithiasis. Lancet 1996; 347: 75-79.

14. Ainsworth AP, Rafaelsen SR, Wamberg PA et al. Is there a difference in Diagnostic Accuracy and Clinical Impact between Endoscopic Ultrasonography and Magnetic Resonance Cholangiopankreatography? Endoscopy 2003; 35: 1029-1032.

15. Scheiman J, Carlos R, Barnett J et al. Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol 2002; 96: 2900-2904.

16. Ledinghen V, Lecesne R, Raymond J et al. Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 2002; 49: 26-31.

17. Materne R, Van Beers B, Gigot J et al. Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 2002; 32: 3-9.

18. Rosch T, Meining A, Fruhmorgen S et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 2003; 55: 870-876.

19. Kozarek RA, Ball TJ, Patterson DJ et al. Endoscopic treatment injury in the era of laparoscopic cholecystectomy. Gastrointest Endosc 1994; 40: 10-16.

20. Procházka V, Konečný M, Král V et al. ERCP v diagnostice a léčbě biliárních komplikací laparoskopické cholecystektomie. Čes Slov Gastroent a Hepatol 1999; 53: 140-144.

21. Kužela L, Oltman M, Šutka J et al. Prospective follow-up of patients with bile duct strictures secondary to laparoscopic cholecystectomy, treated endoscopically with multiple stents. Hepato-Gastroenterology 2005; 52: 1357-1361.

22. Kužela L, Oltman M, Novotná T et al. Liečba benígnych stenóz žlčových ciest vzniknutých po cholecystektómii. Gastroenterol prax 2004; 3: 94-97.

23. Cotton PB, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their mamagement. An attempt at consensus. Gastrointest Endosc 1991; 37: 383-393.

24. Esber EJ, Sherman S The interference of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Gastrointest Endosc Clin N Am 1996; 6: 57-80.

25. Davids PHP, Rauws EAJ, Tytgat GNJ et al. Postoperative bile leakage: Endoscopic management. Gut 1992; 33: 1118-1122.

26. Davids PHP, Tanka AKF, Rauws EA et al. Benign biliary strictures: Surgery or endoscopy? Ann Surg 1993; 217: 237-243.

27. Geenen DJ, Hogan WJ, Geenen JE et al. Long-term follow-up in endoscopic therapy of benign bile duct strictures (abstract). Gastroenterology 1995; 108: A415.

28. Zádorová Z, Zavoral M, Frič P. Endoskopická léčba iatrogenních biliárních stenóz. Endoskopie 1996; 5: 15-17.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 11

2007 Issue 11

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