Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need...Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold standard.In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC.展开更多
Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic(i CCA),perihiliar(ph CCA) and distal. Initial experiences with orthotopic liver transplantation(OLT) for patientsw...Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic(i CCA),perihiliar(ph CCA) and distal. Initial experiences with orthotopic liver transplantation(OLT) for patientswith i CCA and ph CCA had very poor results and this treatment strategy was abandoned. In the last decade,thanks to a strict selection process and a neoadjuvant chemoradiation protocol,the results of OLT for patients with non-resectable phC CA have been shown to be excellent and this strategy has been extended worldwide in selected transplant centers. Intrahepatic cholangiocarcinoma is a growing disease in most countries and can be diagnosed both in cirrhotic and in non-cirrhotic livers. Even though OLT is contraindicated in most centers,recent investigations analyzing patients that were transplanted with a misdiagnosis of HCC and were found to have an iC CA have shown encouraging results. There is some information suggesting that patients with early stages of the disease could benefit from OLT. In this review we analyze the current stateof-the-art of OLT for cholangiocarcinoma as well as the new insights and future perspectives.展开更多
AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were ...AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.展开更多
Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficul...Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficult.We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice.Magneticresonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct(CBD).Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones.This procedure started with the patient in a supine position and the endoscopist at the left side of the table.When the papilla was maintained,the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted.ERCP was performed successfully and relevant complications did not occur in this patient.We also present a review of the literature published between 1985 and 2014in the Pub Med and EMBASE databases.There were eight published cases during this period,with one each from America,Finland,India,Italy,South Korea and Pakistan,and two from Spain.Our case is the first reported in China.展开更多
文摘Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold standard.In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC.
文摘Cholangiocarcinoma is a malignant tumor of the biliary system that can be classified into intrahepatic(i CCA),perihiliar(ph CCA) and distal. Initial experiences with orthotopic liver transplantation(OLT) for patientswith i CCA and ph CCA had very poor results and this treatment strategy was abandoned. In the last decade,thanks to a strict selection process and a neoadjuvant chemoradiation protocol,the results of OLT for patients with non-resectable phC CA have been shown to be excellent and this strategy has been extended worldwide in selected transplant centers. Intrahepatic cholangiocarcinoma is a growing disease in most countries and can be diagnosed both in cirrhotic and in non-cirrhotic livers. Even though OLT is contraindicated in most centers,recent investigations analyzing patients that were transplanted with a misdiagnosis of HCC and were found to have an iC CA have shown encouraging results. There is some information suggesting that patients with early stages of the disease could benefit from OLT. In this review we analyze the current stateof-the-art of OLT for cholangiocarcinoma as well as the new insights and future perspectives.
文摘AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.
文摘Situs inversus viscerum(SIV)is a rare congenitalcondition characterized by complete transposition of all viscera.This anatomical pathology makes endoscopic retrograde cholangiopancreatography(ERCP)technically difficult.We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice.Magneticresonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct(CBD).Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones.This procedure started with the patient in a supine position and the endoscopist at the left side of the table.When the papilla was maintained,the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted.ERCP was performed successfully and relevant complications did not occur in this patient.We also present a review of the literature published between 1985 and 2014in the Pub Med and EMBASE databases.There were eight published cases during this period,with one each from America,Finland,India,Italy,South Korea and Pakistan,and two from Spain.Our case is the first reported in China.
