Aged ; Biliary Tract Diseases ; surgery ; China ; Humans

Biliary tract diseases have always been one of the important indications for liver transplantation. These biliary tract diseases include congenital atresia of biliary duct, biliary diseases with tendency of malignant transformation, malignant biliary diseases, primary biliary cirrhosis, and secondary biliary cirrhosis. The right time to consider liver transplantation for the above biliary diseases includes situations when transplantation is the only approach to treat the disease, the only effective approach to treat the disease, or one of the effective approaches to treat the disease. Currently there is still no commonly accepted pre-operative evaluation standard for biliary disease-related liver transplantation. However, it is important to obey the following principles. First, the diagnosis should be confirmed; secondary, the necessity or urgency of the liver transplantation should be clarified; and third, the patient and his/her family should understand the whole procedure of transplantation the risk and advantage of the surgery, and the potential life-long intake of immunosuppressors. This article will briefly review all these relavant issues based on the authors' personal experience and clinical cases.
Biliary Atresia ; surgery ; Biliary Tract Diseases ; surgery ; Humans ; Liver Cirrhosis, Biliary ; surgery ; Liver Transplantation ; Living Donors

No abstract available.
Biliary Tract Diseases/*surgery ; Catheterization/*methods ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Female ; Humans ; Male ; Sphincterotomy, Endoscopic/*methods

Biliary Tract Diseases ; complications ; surgery ; Humans ; Hypertension, Portal ; complications ; etiology ; surgery ; Liver Cirrhosis ; complications ; surgery ; Perioperative Care

Bile Duct Neoplasms ; surgery ; Bile Ducts ; pathology ; surgery ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; trends ; Cholecystectomy, Laparoscopic ; methods ; trends ; Cholelithiasis ; surgery ; Humans

No abstract available.
Biliary Tract Diseases/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Endosonography/*adverse effects ; Female ; Humans ; Obstetric Surgical Procedures/*adverse effects ; Pancreatic Diseases/*surgery ; Pregnancy ; Pregnancy Complications/*surgery

BACKGROUNDCurrently, the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure, either empirically (with no radiographic guidance) or with ultrasound guidance. However, few published studies compared these two ways. This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.

METHODSThe clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively. ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B). Data on the following variables were compared between the two groups: surgical success rate, rate of complete stone removal, time to resolution of clinical manifestations and laboratory indicators, length of hospital stay, complications, outcome and differences in efficacy of ERCP during different stages of pregnancy.

RESULTSIn group A, the rates of surgical success and complete removal of stones were 69% and 60%, respectively; the corresponding values were 91% and 89% in group B (P < 0.05). Postoperatively, clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P > 0.05). Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64 ± 1.83) days vs. (14.57 ± 3.74) days, (14.29 ± 4.64) days vs. (20.00 ± 5.40) days, P < 0.01). The hospital stay was shorter in group B ((16.28 ± 7.25) days vs. (28.00 ± 6.83) days, P < 0.001). The complication rate was 14% in group A and 3% in group B (P < 0.05). There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.

CONCLUSIONSIn the treatment of acute pancreaticobiliary disease during pregnancy, ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners. Its more widespread use is recommended.

Acute Disease ; Adult ; Biliary Tract Diseases ; surgery ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Humans ; Pancreatic Diseases ; surgery ; Pregnancy ; Pregnancy Complications ; surgery ; Retrospective Studies ; Ultrasonography, Interventional

Obesity is a serious disorder that increases morbidity and mortality. Primary intervention with life style modification and medication is not always effective for obese patients. Endoscopic management of obesity may be a less invasive, more cost-effective, and relatively safer option than bariatric surgery. Moreover, therapeutic endoscopy is considered to be the primary modality for managing complications that occur after bariatric surgery. In the near future, role of gastroenterologists will be more important in the management of obesity and its related problems.
Bariatric Surgery/adverse effects ; Biliary Tract Diseases/etiology ; Endoscopy, Gastrointestinal ; Gastric Balloon ; Gastric Bypass ; Humans ; Obesity/*therapy ; *Physician's Role

Biliary Tract Diseases ; etiology ; surgery ; therapy ; Blood Loss, Surgical ; prevention & control ; Graft Rejection ; etiology ; therapy ; Humans ; Liver Transplantation ; adverse effects

An obstructed biliary system is usually drained by endoscopic retrograde cholangiopancreatography, and when this is unsuccessful, the standard alternative technique is percutaneous transhepatic biliary drainage. Surgical biliary bypass may also be required. In recent years, endosonography has transformed from a solely diagnostic procedure to one with therapeutic capabilities. Endosonography-guided biliary drainage is now being performed as an alternative to percutaneous transhepatic biliary drainage. This is an evolving field, with challenges that must be addressed before it can become a routine clinical practice. This review summarises the current status of endosonography-guided biliary drainage.
Bile Ducts ; diagnostic imaging ; pathology ; Biliary Tract ; physiology ; Biliary Tract Diseases ; diagnostic imaging ; surgery ; Cholangiography ; methods ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Cholestasis ; diagnostic imaging ; surgery ; Drainage ; methods ; Endosonography ; methods ; Humans ; Models, Biological ; Stents