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Article
The Safety of Endoscopic Retrograde Cholangio Pancreatography (ERCP) in Elderly (over 80), Patients: Single Centre Experience

Authors: P Harte --- K Walsh --- Ali Alshareefy
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2012 Volume: 9 Issue: 3 Pages: 716-720
Publisher: Babylon University جامعة بابل

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Abstract

AbstractBackground: ERCP is an invasive procedure which combines the use of x ray and endoscopy to provide a reliable way for diagnosis and treatment of hepatobiliary diseases. The diagnostic role of ERCP has largely been replaced by MRCP (Magnetic Resonance cholangiopancreatography). The valuable use of ERCP has, however, been associated with significant morbidity and mortality. Aims: 1) determine the safety of ERCP procedure in elderly patients. 2) compare the local complication rates with international standards using international large scale studies and British Society of Gastroenterology audit rates as standards. Patients and Methods: 1) Retrospective study on 106 elderly patients (over 80) 2)Cases were identified using local register and profoma used to collect data. 3)Completed data were submitted for collation and statistical analysis. Results: The research revealed the following rates for local complications. 1) acute pancreatitis: 5%. 2) Hemorrhage: 0%. 3) Acute cholangitis: 1%. 4) Dudenal perforation: 0%. 5) Death: 1%. Conclusions: 1) Elderly patients tolerate ERCP as good as young patients despite their advanced age and co-morbidities. 2) The local complication rates fall within the international ranges

Keywords

ERCP --- Pancreatitis --- cholangitis --- Perforation


Article
endoscopic management of common bile duct stones

Authors: haider Kadhum --- Tharwat I. Sulaiman ثروت ادريس سليمان --- Nawal ali --- kassim Fadhil
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2006 Volume: 48 Issue: 2 Pages: 112-118
Publisher: Baghdad University جامعة بغداد

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Abstract


Article
REVIEW OF THE CAUSES OF OBSTRUCTIVE JAUNDICE AND THE ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATICOGRAPHY (ERCP) IN THE MANAGEMENT

Author: Saad N.K. Saadoon د. سعد ناظم خلخال سعدون
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2016 Volume: 14 Issue: 4 Pages: 359-365
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Obstructive jaundice poses diagnostic and therapeutic challenges to practicing physician gastroenterologist and general surgeons.Objective:To highlight the etiological spectrum, treatment outcome of obstructive jaundice endoscopically by Endoscopic Retrograde Cholangiopancreaticography (ERCP).Methods:It is a cross sectional case series study included 140 patients who presented with obstructive jaundice and dilated biliary system. They managed at Gastroenterology and Hepatology Center in Al-Imamein Al-kadhimein Medical City, Baghdad, Iraq from April 2012 to April 2014. All the patients were offered abdominal sonagraphy (U/S), magnetic resonance cholangiopancreaticography (MRCP) and upper endoscopy, as well as other laboratory work up, in order to prepare them for either palliative or curative treatment by the ERCP. Both success rate and complications were reported.Results:Common bile duct (CBD) stones were confirmed in 100 patients (71.4%) (56 female and 44 male) while pancreatic-biliary tumors found in 25 patient (17.8%) (15 male and 10 female) as pancreatic tumor in 11 patients, periampulary and ampulary tumor in 5 patients and cholangiocarcinoma in 4 patients while the rest due to metastasis. Benign causes as biliary fibrosis was seen in (10.8%). The success rate of ERCP treatment was 87.2%, but complications represented 6.4%. All of them were mild and reported within 24 hours.Conclusion: CBD stones are the predominant cause of benign cause of surgical obstructive jaundice, while the carcinoma of head of pancreas is the commonest concerning malignant causes. ERCP is very safe and effective procedure in the management.Keywords: CBD stone, Obstructive jaundice, ERCP, gallstone.


Article
Epidemiology of Malignant Extra-Hepatic Biliary Tract Obstruction Detected

Author: Omed H.K Abdulwahab
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 1 Pages: 102-106
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: One of the important causes of obstructive jaundice is malignant tumours. OBJECTIVE:The current study was undertaken to describe the epidemiology of malignant extra-hepatic biliary tract obstruction in Sulaimaniyah, Kurdistan Region, Iraq. Patients & Methods: The study was undertaken at Kurdistan centre for gastroenterology & hepatology in Sulaimaniyah city. Patients attending the centre during the period from 1st January 2008 to 1st January 2013 and diagnosed as having a malignancy using endoscopic retrograde cholangiopancreatography were included in the study. A total of 259 patients were found to have such a malignancy and therefore included. RESULTS:The mean age of patients was 63.5 years, the male to female ratio was 1:3 and the most common cause of malignant extra-hepatic biliary tract obstruction was cholangiocarcinoma 47.5%, followed by ampullary and peiampullary carcinoma 26.6%. In males, 37.7% of cancers were cholangiocarcinoma, 30.8% ampullary and periampullary carcinoma, & 26% pancreatic carcinoma, versus 60.2%, 21.2%, & 15% in females respectively (P= 004). Most cancers occurred between 50-79 years of age.CONCLUSION: The causes of malignant extra-hepatic biliary obstruction in order of frequency were cholangiocarcinoma, ampullary and periampullary carcinoma, pancreatic carcinoma & carcinoma of the gallbladder.


Article
Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.


Article
Management of Obstractive Jaundice Due to Common Bile Duct Stone in Baghdad Teaching Hospital
علاج اليرقان الانسدادي الناتج عن حصاة القناة الصفراوية المشتركة في مستشفى بغداد التعليمي

Authors: Akram A. Almosswi اكرم الموسوي --- Hussain A. Turky حسين علي تركي --- Tharwat I. Sulaiman ثروت ادريس --- Adel H. Jabur عادل هاشم جبر
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2014 Volume: 56 Issue: 3 Pages: 283-286
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm) Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.Key wards: CBD stones, endoscopic management, surgical intervention

خلفيه الموضوع: اكثر اسباب اليرقان الانسدادي هو حصا القناه الصفراء,وهذا يمكن ان يولد مضاعفاه ووفياه مهمه.معالجه اليرقان الانسدادي الناتج من حصاه ه قناه الصفراء في تطور,عده طرق تشخيصيه وعلاجيه ادخلت في هذا الموضوع وكل منها له فوائده ومضاره.هدف الدراسه:لغرض دراسه وتقييم معالجه اليرقان الانسدادي الناتج عن حصاه القناه الصفراء في مستشفى بغداد التعليمي.المرضى والوسائط :دراسه مستقبليه مكونه من 111 مريض لديهم اعراض سريريه ونتائج مختبريه وصوريه تقترح وجود يرقان انسدادي ناتج عن حصاه القناه الصفراء عولجو في مستشفى بغداد التعليمي في الفتره من كانون الثاني 2011 الى تشرين الثاني 2011 14 مريض اخر ابعدو من الدراسه بسبب ثبوت ان سبب اليرقان الانسدادي لديهم كان باسباب اخرى.العمل المبذول لكل مريض كان اخذ تاريخ المرض والفحص السريري وفحوصات مختبريه فحص الامواج فوق الصوتيه (السونار) للبطن.نفس المرضى تعرضوا لعمليه تنظير القناه الصفراء لسببين لغرض التشخيص واستخراج حصاه قناه الصفراء .مريضين فقط ارسلوا مباشره الى العلاج الجراحي كان لديهم (متلازمه ميريزي).كذالك اجريت العمليات الجراحيه للمرضى الذين فشلت لديهم المعالجه الناظوريه.النتائج:من ال125 مريض الذين لديهم يرقان انسدادي والذين انضموا لهذه الدراسه ,14مريض لديهم اسباب غير حصاه القناه الصفراء ابعدوا من هذه الدراسه, فاصبح العدد الكلي للمرضى 111 مريض46 ذكر و65 انثى .جميع المرضى ليهم اعراض سريريه ولديهم نتائج تحاليل وظائف كبد غير طبيعيه , اجري الفحص السوناري لجميع المرضى ,وفحص الرنين المغناطيسي للقنوات الصفراء والبنكرياس اجري ل26 مريض وفحص السونار عن طريق ناظور المعده والاثني عشر ل9 مرضى ,4 مرضى كان لديهم حصاه القناه الصفراء الاوليه, 95 مريض كان لديهم حصاه القناه الصفراء الثانويه , 9 مرضى كان لديهم حصاه القناه الصفراء المحفوظه , و3 مرضى لديهم (متلازمه ميريزي ).المعالجه المنظاريه اجريت ل 108 مريض نجحت في 90% من المرضى.العلاج الجراحي اجري ل 13 مريض 10 منهم بعد فشل العلاج المنظاري و3 مرضى كان لديهم (متلازمه ميريزي) .الاستنتاجات:العلاج الناظوري لاستخراج حصاه القناه الصفراء المتبوع برفع المراره ما زال الطريقه الرشيده في علاج حصاه القناه الصفراء . حصاه القناه الصفراء الكبيره وتعددها ما زالا الاسباب الاكثر شيوعا لفشل العلاج المنظاري لاستخراج حصاه القناه الصفراء والعلاج الجراحي ,في هذه الدراسه كان هنالك نسبه حصاه محفوظه في القناه الصفراء اعلى من الدراسات المذكوره في الدول الغربيه,بسبب عدم وجود فحوصات خلال العمليه تجرى لغرض تشخيص حصاه القناه الصفراء لغرض تلافي ترك حصا في القناه الصفراء في مستشفانا مفتاح الكلمات: حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

Keywords

Background: the most common cause of obstructive jaundice is CBD stones --- and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution --- several methods of investigations and treatment have been introduced --- and each one has its own advantages and disadvantages. Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital. Patients and methods: a prospective study of 111 patients with clinical --- laboratory --- and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011 --- other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them --- MRCP for 26 patients --- and EUS for 9 patients. Four patients had primary stones --- 95 patients had secondary stones --- 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions --- and they were excluded from the study --- so the total number of the patients was 111 --- 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients --- 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone --- more than 15mm Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries --- because there is no intraoperative screening to avoid missing CBD stones in our hospital. Key wards: CBD stones --- endoscopic management --- surgical intervention --- حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

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