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Acute Gallstone Cholangitis

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1. Management of Acute Gallstone Cholangitis after Roux-en-Y Gastric Bypass with Laparoscopic Transgastric Endoscopic Retrograde Cholangiopancreatography. (PubMed)

Management of Acute Gallstone Cholangitis after Roux-en-Y Gastric Bypass with Laparoscopic Transgastric Endoscopic Retrograde Cholangiopancreatography. The incidence of biliary lithiasis is increased after bariatric surgery due to rapid weight loss [1]. Trans-oral endoscopic management in cases of common bile duct gallstone complication is not possible in patients with Roux-en-Y gastric bypass (RYGB) due to the modified anatomy. Access to the biliary tree after RYGB with a classical direct (...) surgical approach of common bile duct and choledocoscopy can be used, but may be complicated in situations of acute cholangitis because of the fragility of common duct, or in cases of previous cholecystectomy. Multiple alternatives have been described, such as percutaneous transhepatic cholangiography or laparoscopic transgastric endoscopic retrograde cholangiopancreatography (LTG-ERCP) [2, 3]. The aim of this video was to present the management of common bile duct gallstone complication after RYGB

2018 Obesity Surgery

2. Acute Gallstone Cholangitis

Acute Gallstone Cholangitis Acute Gallstone Cholangitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Gallstone Cholangitis (...) Acute Gallstone Cholangitis Aka: Acute Gallstone Cholangitis , Ascending Cholangitis , Cholangitis , Suppurative Cholangitis , Charcot's Triad , Reynold's Pentad , Acute Cholangitis From Related Chapters II. Epidemiology rare under age 40 years However can occur in children with risk factors III. Risk Factors Choledocolithiasis Biliary atresia or Biliary tract stricture Surgical anastomotic stricture Extrinsic compression from malignancy transplant history Roux-en-Y Bypass Surgery IV

2018 FP Notebook

3. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. (PubMed)

Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute gallstone pancreatitis remains controversial. A number of clinical trials and meta-analyses have provided conflicting evidence.To systematically review evidence from randomized controlled trials (RCTs) assessing the clinical effectiveness and safety of the early (...) routine ERCP strategy compared to the early conservative management with or without selective use of ERCP strategy, based on all important, clinically relevant and standardized outcomes including mortality, local and systemic complications as defined by the Atlanta Classification (Bradley 1993) and by authors of the primary study, and ERCP-related complications in unselected patients with acute gallstone pancreatitis.We searched the CENTRAL (The Cochrane Library), MEDLINE, EMBASE, and LILACS databases

2012 Cochrane

4. Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis

Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis Uy MC, Daez ML, Sy PP, Banez VP, Espinosa WZ, Talingdan-Te MC CRD summary The authors concluded that there was a trend towards increased mortality with early endoscopic retrograde cholangiopancreatography with or without endoscopic sphincterotomy in patients (...) with acute gallstone pancreatitis without cholangitis. Given the small number of studies and differences between studies, the authors’ conclusions may not be reliable and should be interpreted with caution. Authors' objectives To evaluate the effects of early endoscopic retrograde cholangiopancreatography (ERCP) on morbidity and mortality of patients with acute gallstone pancreatitis without cholangitis. Searching MEDLINE, EMBASE, The Cochrane Library, AMI, LILACS and Health Research and Development

2009 DARE.

5. The impact of empiric endoscopic biliary sphincterotomy on future gallstone-related complications in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed. (PubMed)

recurrent pancreatitis, however other gallstone-related complications (GCs) may still develop. We aimed to determine the impact of ES on future GCs in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed.During 2006-2016, we included patients with non-severe ABP while those with severe pancreatitis and concurrent cholangitis were excluded. GC events were compared between those who had DC with ES and those who had DC without ES. A similar comparison (...) The impact of empiric endoscopic biliary sphincterotomy on future gallstone-related complications in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed. Early cholecystectomy (EC) is recommended in patients with acute biliary pancreatitis (ABP). In real-life practice, cholecystectomy is frequently deferred due to various reasons and delayed cholecystectomy (DC) is performed instead. Endoscopic sphincterotomy (ES) is an alternative to prevent

2018 Surgical endoscopy

6. BSG and UKPBC primary biliary cholangitis treatment and management guidelines

BSG and UKPBC primary biliary cholangitis treatment and management guidelines 1 Hirschfield GM, et al. Gut 2018;0:1–27. doi:10.1136/gutjnl-2017-315259 Guidelines The British Society of Gastroenterology/UK- PBC primary biliary cholangitis treatment and management guidelines Gideon M Hirschfield, 1,2,3 Jessica K Dyson, 4,5,6 Graeme J M Alexander, 7,8 Michael H Chapman, 9 Jane Collier, 10 Stefan Hübscher, 3,11 Imran Patanwala, 12,13 Stephen P Pereira, 7,8,9 Collette Thain, 14 Douglas Thorburn, 7,8 (...) Dina Tiniakos, 5 Martine Walmsley, 15 George Webster, 9 David E J Jones 4,5,6 ABSTRACT Primary biliary cholangitis (formerly known as primary biliary cirrhosis, PBC) is an autoimmune liver disease in which a cycle of immune mediated biliary epithelial cell injury, cholestasis and progressive fibrosis can culminate over time in an end-stage biliary cirrhosis. Both genetic and environmental influences are presumed relevant to disease initiation. PBC is most prevalent in women and those over the age

2018 British Society of Gastroenterology

7. Acute cholangitis - an update (PubMed)

Acute cholangitis - an update Acute cholangitis is bacterial infection of the extra-hepatic biliary system. As it is caused by gallstones blocking the common bile duct in most of the cases, its prevalence is greater in ethnicities with high prevalence of gallstones. Biliary obstruction of any cause is the main predisposing factor. Diagnosis is established by the presence of clinical features, laboratory results and imaging studies. The treatment modalities include administration of intravenous

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2018 World journal of gastrointestinal pathophysiology

8. Gallstone disease: diagnosis and initial management

population are thought to have gallstone disease, and most of these people experience no symptoms. For a small proportion of people with gallstone disease, the stones irritate the gallbladder or block part of the biliary system, and this can cause symptoms such as pain, infection and inflammation. If these symptoms are left untreated, gallstones can cause more serious and in some cases life-threatening conditions such as cholecystitis, cholangitis, pancreatitis and jaundice. There is variation in how (...) Gallstone disease: diagnosis and initial management Gallstone disease: diagnosis and Gallstone disease: diagnosis and management management Clinical guideline Published: 29 October 2014 nice.org.uk/guidance/cg188 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. Patient-Reported Outcomes for Acute Gallstone Pathology. (PubMed)

), pancreatitis (10), common bile duct stones (3) and cholangitis (2). The top-scoring survey item was "long-term quality of life after surgery", with a median value of 97 out of 100. Other high-scoring items included "cleanliness of the ward environment" and "pain control after surgery" (both 96). The lowest-scoring item was "being treated as a daycase" (54).Patients with acute gallstone pathology view long-term quality of life after surgery as the most important factor and daycase surgery as the least (...) Patient-Reported Outcomes for Acute Gallstone Pathology. A number of prominent surgical trials and clinical guidelines regard length of hospital stay and rates of daycase surgery as being of upmost importance following cholecystectomy. However, it is unclear whether these outcomes also matter to patients. This study aimed to identify the factors patients regard as most important when admitted with acute gallstone pathology.A 41-item survey was produced by combining outcomes assessed in recent

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2017 World Journal of Surgery

10. Temporal trends in utilization and outcomes of endoscopic retrograde cholangiopancreatography in acute cholangitis due to choledocholithiasis from 1998 to 2012. (PubMed)

 ± 6122 in 2012).In-patient admissions for CDC and ERCP rates have increased significantly, particularly evident after 2006-2007. This may be attributed to increasing incidence of gallstones and wider implementation of Tokyo guidelines for the management of acute cholangitis. In-hospital morality and LOS reduced significantly in early ERCP group, whereas hospital charges increased most significantly in delayed ERCP group. (...) Temporal trends in utilization and outcomes of endoscopic retrograde cholangiopancreatography in acute cholangitis due to choledocholithiasis from 1998 to 2012. Expeditious endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis with biliary decompression is associated with better outcomes. In this study, we evaluated the temporal trends of ERCP utilization and healthcare outcomes among patients hospitalized with acute cholangitis due to choledocholithiasis (CDC) from 1998

2017 Surgical endoscopy

11. Gallstones

disease, such as acute cholecystitis, cholangitis, or pancreatitis. Urgent referral should be arranged for people with known gallstones and jaundice, or if there is a clinical suspicion of biliary obstruction (for example, significantly abnormal liver function tests). All other people with symptomatic gallstone disease should be referred to a surgeon for consideration of laparoscopic cholecystectomy, with the referral urgency dependent on clinical judgment. Appropriate pain relief should be offered (...) incidences of 8% or less depending on the length of follow-up. Cholecystectomy rates varied across studies, but the highest cholecystectomy incidence was 25.8% over 10 years. In a study which reviewed the records of 40,819 people who had had a cholecystectomy in California in the 1990s, the spectrum of gallstone disease identified from the records included biliary colic (56%), acute cholecystitis (36%), acute pancreatitis (4%), choledocholithiasis (3%), gallbladder cancer (0.3%), and cholangitis (0.2

2019 NICE Clinical Knowledge Summaries

12. Acute cholangitis in an old patient with Crigler-Najjar syndrome type II - a case report. (PubMed)

Acute cholangitis in an old patient with Crigler-Najjar syndrome type II - a case report. Crigler-Najjar syndrome (CN) is a very rare genetic disorder characterized by an inability to conjugate bilirubin. Contrary to CN type I, patients with CN II exhibit residual capacity to conjugate bilirubin and may present a normal life expectancy.We report an unusual late diagnosis of CN type II in an 80-year-old female admitted with severe acute cholangitis. While the patient present typical clinical (...) and radiologic signs of bile duct obstruction and cholangitis, her blood analysis showed severe unconjugated hyperbilirubinemia. Endoscopic retrograde cholangiopancreatography confirmed the diagnosis and allowed therapeutic intervention. The anatomopathologic examination of her gallbladder following cholecystectomy showed signs of chronic cholecystitis.The risk of gallstone disease may be increased in patients with CN syndrome. While unusual, we alert to this curious and potential life-threatening

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2016 BMC Gastroenterology

13. WITHDRAWN. Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. (PubMed)

WITHDRAWN. Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. Early endoscopic retrograde cholangio-pancreatography with or without endoscopic sphincterotomy (ERCP+/-ES) has been advocated to reduce complications in patients presenting with a severe attack of gallstone-associated acute pancreatitis (GAP). However, a recent trial has reported contradictory results. Importantly, patients with acute cholangitis were excluded suggesting it may be a major (...) confounding factor affecting previous studies.To assess the effectiveness of early ERCP+/-ES compared to conservative management stratified according to severity of disease, concealment of randomisation, acute cholangitis and bilirubin level in the reduction of mortality, morbidity, length of hospitalisation and cost in adults suspected of having GAP.We searched - Cochrane Library (Issue 4 2003), Medline (1966-2004), EMBASE (1980-2004) and LILACS. 'Grey literature' was sought by looking at cited

2010 Cochrane

14. Acute Gallstone Cholangitis

Acute Gallstone Cholangitis Acute Gallstone Cholangitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Gallstone Cholangitis (...) Acute Gallstone Cholangitis Aka: Acute Gallstone Cholangitis , Ascending Cholangitis , Cholangitis , Suppurative Cholangitis , Charcot's Triad , Reynold's Pentad , Acute Cholangitis From Related Chapters II. Epidemiology rare under age 40 years However can occur in children with risk factors III. Risk Factors Choledocolithiasis Biliary atresia or Biliary tract stricture Surgical anastomotic stricture Extrinsic compression from malignancy transplant history Roux-en-Y Bypass Surgery IV

2015 FP Notebook

15. Short Duration Versus Fourteen Days Antibiotic in Common Bile Duct Cholangitis

in patient with successful endoscopic drainage. Condition or disease Intervention/treatment Phase Acute Cholangitis Common Bile Duct Calculi Other: Short duration of antibiotic Other: Standard treatment of antibiotic Not Applicable Detailed Description: The aim is comparing the efficacy and safety between short duration and standard fourteen days antibiotic treatment in patients with acute common bile duct stone (CBDS) cholangitis after successful endoscopic biliary drainage as regards recurrence rate (...) of acute cholangitis, complete stone clearance rate, morbidity and mortality associated acute cholangitis, and complications related ERCP procedure. The study will be divided patients with acute CBDS cholangitis with complete stone clearance into 2 groups, group (A) will be received intravenous antibiotic until the temperature is less than 37.8 c for 72 hours and group (B) will be received intravenous antibiotic for 7 days, followed by oral antibiotic for 7 days, regardless of the body temperature

2018 Clinical Trials

16. Early Cholecystectomy in Patients With Mild Gallstone Acute Pancreatitis

Early Cholecystectomy in Patients With Mild Gallstone Acute Pancreatitis Early Cholecystectomy in Patients With Mild Gallstone Acute Pancreatitis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Early (...) Cholecystectomy in Patients With Mild Gallstone Acute Pancreatitis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02590978 Recruitment Status : Terminated (Interim analysis (n=52) with significantly differences in primary outcome (LOS)) First Posted : October 29, 2015 Last Update Posted : September 17, 2018

2015 Clinical Trials

17. Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study. (PubMed)

Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study. It has been suggested that endoscopic sphincterotomy predisposes a patient to cholangitis, pancreatitis, and carcinoma in the pancreaticobiliary tract in the long term. Previous studies have shown an increased risk for acute cholangitis and pancreatitis but not for carcinoma. The aim of this study was to analyze these risks by conducting a long-term (...) , the hazard ratio for endoscopic sphincterotomy versus cholecystectomy was 5.5 (95% confidence interval [CI] 3.5-8.4) for cholangitis and 4.9 (95%CI 2.8-8.6) for pancreatitis. The hazard ratio for endoscopic sphincterotomy versus cholangiotomy was 1.7 (95%CI 1.3-2.4) for cholangitis and 1.5 (95%CI 1.0-2.4) for pancreatitis. There was no significant increase in risk for malignant diagnoses.Patients who underwent endoscopic sphincterotomy for choledocholithiasis had an increased risk for acute pancreatitis

2015 Endoscopy

18. The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center (PubMed)

The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center To evaluate the course and outcomes of pregnant patients with complicated gallstone disease and to reveal the experience of a tertiary center.The records of 92.567 patients were evaluated using searches for diagnoses with the terms of pregnant, pregnancy, gallstone, cholecystitis, cholangitis, choledocholithiasis, pancreatitis, and endoscopic retrograde cholangiopancreatography in pregnancy (...) in the hospital database. Patients' age, week of gestation, parity, body mass index, definitive diagnosis, attack episodes, treatment modalities, and obstetric and neonatal complications were evaluated.Overall, 59 women were diagnosed as having complicated gallstone disease in pregnancy. Acute cholecystitis was the most commonly diagnosed complicated gallbladder disease (62.7%). Cholecystectomy was performed in 15 women during gestation. Perinatal outcomes were as follows: one (1.7%) maternal death, 4 (6.8

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2016 Turkish Journal of Obstetrics and Gynecology

19. Clinical features of gallstone impaction at the ampulla of Vater and the effectiveness of endoscopic biliary drainage without papillotomy (PubMed)

of Vater and to examine the effectiveness of endoscopic biliary drainage without papillotomy.We retrospectively examined 30 patients who had undergone endoscopic treatment for gallstone impaction at the ampulla of Vater between 2010 and 2015.According to the severity classification for acute cholangitis in the Tokyo Guidelines (TG13), the condition was mild in 8 patients, moderate in 14, and severe in only 8 (27 %), despite the stone impaction at the ampulla of Vater. Hyperamylasemia was observed in 18 (...) . Serum amylase levels decreased the following day in all patients, even in Group B (including the 10 patients with hyperamylasemia and the 3 patients with clear pancreatitis on CT).Even with stone impaction at the ampulla of Vater, typical clinical features of cholangitis and pancreatitis are relatively rare. Biliary drainage without papillotomy is acceptable for gallstone impaction at the ampulla of Vater.

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2016 Endoscopy international open

20. Initial cholecystectomy vs sequential common duct endoscopic assessment and subsequent cholecystectomy for suspected gallstone migration: a randomized clinical trial. (PubMed)

Initial cholecystectomy vs sequential common duct endoscopic assessment and subsequent cholecystectomy for suspected gallstone migration: a randomized clinical trial. The optimal management of treatment for patients at intermediate risk of a common duct stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) is a matter of debate. Many stones migrate spontaneously into the duodenum, making preoperative common duct investigations unnecessary.To compare (...) comprised a random sample of 100 adult patients admitted to Geneva University Hospital, Geneva, Switzerland, for acute gallstone-related conditions with an intermediate risk of a common duct stone. Fifty patients were randomized to each group.Cholecystectomy first with intraoperative cholangiogram for the study group and endoscopic common duct assessment and clearance followed by cholecystectomy for the control group.Length of initial hospital stay (primary end point), number of common duct

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2014 JAMA Controlled trial quality: uncertain

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