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PubMedDate not supplied

Immediate cystic duct occlusion using an endoluminal absorbable polyglycolic acid screw.

Endoscopic in situ occlusion of the cystic duct and ablation of the gallbladder could constitute a useful alternative to cholecystectomy in certain patients. The purpose of this study was to examine the feasibility of endoluminal occlusion of the cystic duct using a biodegradable polyglycolic acid screw and simultaneous gallbladder mucosal ablation with a Sotradecol-ethanol mixture. Eight pigs had operative cholecystotomy. A polyglycolic acid screw was twisted into the cystic duct after the proximal cystic duct mucosa was thermally ablated using electrocautery. Cholecystography confirmed occlusion of the cystic duct. Synchronous ablation of the gallbladder mucosa was then done by instilling absolute alcohol and 2% Sotradecol. The gallbladder was drained. Animals were sacrificed on days 14, 28, and 42. All animals survived operation and showed no untoward effects. Postmortem gross inspection showed gallbladders were shrunken and surrounded with adhesions from adjacent tissue. Cholangiography and cholecystography confirmed occlusion of the cystic duct in 6 of 8 pigs (75%). Histopathologic examination showed extensive areas of mucosal necrosis mixed with small areas of epithelial regeneration. Immediate occlusion of the cystic duct is possible using an endoluminal polyglycolic acid screw.

Animals↗

PubMed1981

Comparison of intravenous and intramuscular sincalide (C-terminal octapeptide of cholecystokinin) on gallbladder contraction in man.

The effects of intramuscular and intravenous sincalide on gallbladder contraction and visualization of the bile ducts were compared in a group of 37 subjects referred for oral cholecystography. The maximum reduction in gallbladder size observed after sincalide 400 ng/kg intramuscular, 54.7 +/- 7.2% (mean +/- SEM), occurred 25 min after injection and was significantly greater than that observed after sincalide 20 ng/kg intravenous, 26.5 +/- 8.2%. Maximum reduction after sincalide 100 ng/kg intramuscular was 47.3 +/- 8.2%. The common bile duct was visualized in 60 and 45% of subjects after intramuscular and intravenous sincalide, respectively. The use of intramuscular sincalide 400 ng/kg intramuscular is an effective and convenient adjunct to oral cholecystography when significant gallbladder contraction and visualization of the common bile duct is desired.

Adolescent↗

PubMed1978

Role of ultrasonography in the primary diagnosis of cholelithiasis: an analysis of fifty cases.

The use of ultrasonography to diagnose cholelithiasis has recently been recommended to supplement standard reinforced oral cholecystography or as an alternative to reinforced oral studies when a single dose fails to visualize the gallbladder. As yet the use of ultrasonography in the primary diagnosis of cholelithiasis is not generally accepted. To assess the specificity and sensitivity of this mode of diagnosis, fifty patients were reviewed retrospectively. The findings of ultrasonography are compared with standard oral cholecystography and with the pathologic findings. The results of this analysis suggest that diagnosis of cholelithiasis by ultrasonography has a high level of accuracy. Use of this mode of evaluating the gallbladder is suggested as a primary diagnostic test for jaundiced or pregnant patients.

Adult↗

PubMed1978

Ultrasonic examination of the gallbladder: a review.

Ultrasonography is a helpful, non-invasive, and relatively inexpensive adjuvant to oral cholecystography for evaluating the gallbladder and its diseases. This method can be highly accurate in detecting gallstones and is specially useful when there is non-visualisation in radiographic contrast studies. Various ultrasound patterns of gallstones are described. All these patterns should demonstrate a sonic shadow in association with an intraluminal defect. Sonography is particularly useful in demonstrating cholelithiasis and organ dilatation in suspected acute cholecystitis. In addition to gallbladder disease, this technique simultaneously offers pertinent anatomical information about the porta hepatis. This information would otherwise require additional diagnostic investigation. Because, in many instances, sonography is non-specific, or blind to certain gallbladder non-calculous filling defects, and because of present lack of uniform standard quality control methods for performing this procedure, it should be considered only as a complementary, imaging procedure to oral cholecystography.

Acute Disease↗

PubMed1991

Delayed gallbladder rupture following percutaneous cholecystostomy.

Percutaneous cholecystostomy has become an accepted therapeutic alternative for high-risk patients with acute cholecystitis. However, some authors have cautioned that patients with gallbladder wall necrosis and gangrene may not be effectively treated by means of percutaneous drainage alone. A case is reported in which gallbladder wall necrosis progressed following technically successful percutaneous drainage. Spontaneous gallbladder rupture ensued, necessitating emergent cholecystectomy. Cholecystography 2 weeks following tube placement and 1 week prior to rupture showed a markedly abnormal, irregular gallbladder lumen. The authors suggest that follow-up cholecystography may be a useful tool for evaluating patient response to percutaneous cholecystostomy and for determining subsequent patient management.

Acute Disease↗

PubMed1981

Identification of patients with cholesterol or pigment gallstones by discriminant analysis of radiographic features.

In a search for a way to distinguish cholesterol gallstones from pigment gallstones by oral cholecystography, we evaluated 56 patients with surgically confirmed cholelithiasis. Only buoyancy was highly predictive of gallstone composition: all 14 patients with floating stones had cholesterol stones (P less than 0.01), but only one third of the patients with cholesterol stones had stone buoyancy. Using a function derived by stepwise discriminant analysis, we separated patients with cholesterol stones from those with pigment stones. The predictive accuracy was significantly improved: sensitivity was 95 per cent (37 of 39 patients with cholesterol stones), specificity was 82 per cent (14 of 17 patients with pigment stones), and efficiency was 91 per cent (51 of 56 total patients). The resultant function, applied prospectively to 17 additional cases, classified all of them correctly. In patients with cholelithiasis and gallbladders visualized on oral cholecystography, discriminant analysis can improve the prediction of gallstone composition and the subsequent selection of medial or surgical therapy.

Adult↗

PubMed1979

Fine-needle cholangiography (FNC) in the nonjaundiced patient.

Fine-needle cholangiography (FNC) in the jaundiced patient is well established, but its role in the diagnostic work-up of nonjaundiced patients has not been emphasized. We present 44 consecutive nonjaundiced patients with a serum bilirubin level of 2.4 mg% of less who underwent FNC. The indications were recurrent RUQ pain (77%), painless cholestasis (16%), and relapsing pancreatitis (7%). In all but two patients, one or more inconclusive techniques [oral cholecystography, ultrasonography, intravenous cholangiography, or endoscopic retrograde cholangiography (ERC)] had been employed prior to FNC. Biliary tract opacification was successful in 35 of 44 (80%). In nine of 35 (26%) choledocholithiasis and/or cholelithiasis was present. In four (11%) a significant extrahepatic biliary stricture was noted. More than five needle insertions were often required for successful entry. No complications occurred. Indications for FNC should be extended to include nonjaundiced patients with RUQ pain or painless cholestasis in whom oral cholecystography, ultrasonography, and intravenous cholangiography have been of no diagnostic help. The relative ease and low cost of FNC make it preferable to ERC in these patients.

Adolescent↗

PubMed1993

Efficacy of bile acid therapy for gallstone dissolution: a meta-analysis of randomized trials.

To define better the efficacy of bile acid therapy for dissolution of radiolucent gallstones, we performed a meta-analysis of published trials from January 1966 to September 1992. Studies were identified using a MEDLINE computer search followed by an extensive manual search. The inclusion criteria used were: randomized trial, radiolucent gallstones in a visualizing gallbladder on oral cholecystography, and complete stone dissolution confirmed by oral cholecystography or ultrasound. Study results were pooled into 6 groups: placebo: high- and low-dose chenodeoxycholic acid (CDCA) (> or = 10 mg.kg/day and < 10 mg.kg/day); high- and low-dose ursodeoxycholic acid (UDCA) (> or = 7 mg.kg/day and < 7 mg.kg/day) and combined CDCA plus UDCA. Homogeneity calculations were performed and the percentage of complete stone dissolution calculated for each group with 95% confidence intervals. Of 66 trials identified, 23 comprising 1949 patients met the inclusion criteria. A total of 1062 patients were treated with CDCA, 819 with UDCA and 78 combination therapy. In studies > 6 months' duration, high-dose UDCA completely dissolved stones in 37.3% of patients (95% C.I. 33-42%), low-dose UDCA in 20.6%) and high-dose CDCA 18.2% (95% C.I. 15-21%). Based on only two studies, combination therapy achieved dissolution in 62.8% (95% C.I. 51-74%) of patients. Stones less than 10 mm dissolved significantly more frequently than stones larger than 10 mm. This analysis shows that UDCA in doses greater than 7 mg.kg/day taken for greater than 6 months will dissolve radiolucent gallstones in 38% of patients. The combination of UDCA and CDCA may be more efficacious but this observation is based upon only 78 patients and requires confirmation in further randomized trials.

Chenodeoxycholic Acid↗

PubMed1995

Prediction of gall stone composition by ultrasound: implications for non-surgical therapy.

Oral cholecystography is the basic radiodiagnostic procedure required to assess chemical composition of gallstones as well as functional status of gall bladder prior to non-surgical management of gallstones. However, the value of ultrasound in non-surgical management of gallstones is yet to be proved. In this study we attempt to establish sonographic criteria which will predict the composition of gallstones prior to their non-surgical treatment. For this purpose the ultrasonographic characteristics of 233 patients with gallstone disease and functioning gall bladders were studied and an effort was made to correlate cholesterol and calcium content of different types of stones (as estimated by X-Ray powder diffraction study and atomic absorption spectrophotometry) with their ultrasonographic characteristics. Sonographic criteria for the presence of cholesterol stones were those which were floating and gallstones producing acoustic shadowing without internal echoes from within the stone. In detecting findings which would predict the presence of cholesterol stones on ultrasound, ultrasound had a sensitivity of 72.90% and a specificity of 100%. The predictive values of positive findings and negative findings were 100% and 93.4%, respectively. The demonstration of typical features of cholesterol stones on ultrasound obviates the need for oral cholecystography.

Calcium↗

PubMed1980

The effects of iopodate on the serum iodothyronine pattern in normal subjects.

The ingestion by normal subjects of 3 g of sodium iopodate, which is widely used in routine oral cholecystography, resulted in significant decreases of serum total and free T3 to a nadir on day 4 which averaged 43% and 40%, respectively, below initial mean values. Total and free rT3 increased markedly to a peak on day 3, 244% and 189%, respectively, above initial mean values. Total and free T4 and free T4 index rose to a maximum on day 4, but these changes were not statistically significant. A marked TSH increase was also seen, most evident on day 3. All these changes reverted to baseline values by day 14 at a time when serum total iodide was still markedly elevated. It is concluded that the changes observed after iopodate were not due to alterations in serum binding proteins nor to an effect on thyroid gland by the large iodine component of iopodate, but were consistent with an effect on the peripheral metabolism of T4. Difficulty in interpreting routine thyroid function tests may occur for up to 14 days after oral cholecystography with iopodate.

Adult↗

PubMed1977

Gallbladder disease in cystic fibrosis.

In 84 consecutive patients with cystic fibrosis, oral cholecystography was abnormal in 39 (46.4%). The incidence of abnormal cholecystograms increased with patient age. The 26 patients with a nonvisualized gallbladder following double-dosage oral cholecystography were evaluated with intravenous cholangiography; 19 (70.3%) of these were abnormal. Ten patients were found to have calculi, an incidence of 11.9%. Awareness of the high incidence of cholecystographic abnormalities and calculi should be helpful in the evaluation of patients with cystic fibrosis, particularly since symptoms of abdominal pain are frequent in such patients and may lead to radiographic investigations.

Adolescent↗

PubMed1986

Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation.

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.

Adult↗

PubMed1990

[The use of echo- and scintigraphic study of the biliary system in chronic cholecystitis].

Data are reported of a study of the functional state of the biliary in 50 patients with chronic cholecystitis by means of complex employment of dynamic echo- and cholecystography and dynamic computerized gamma-hepatobilioscintigraphy. It was found that dynamic echo- and cholecystography proved highly efficient indicating that ultrasound tomography is of importance not only the diagnosis of structural but also functional disorders in cholecystitis, for the choice of optimal tactics and evaluation of the efficacy of therapeutic measures excluding radiation treatment.

Adult↗

PubMed1990

Oral dissolution therapy for cholelithiasis: mix and match.

The authors conducted a prospective, randomized trial of chenodeoxycholic and ursodeoxycholic acid versus ursodeoxycholic acid alone in patients with cholelithiasis to determine their efficacy for dissolution of gallstones. One hundred and twenty patients with radiolucent gallstones, less than or equal to 15 mm and who had a functioning gallbladder were enrolled. The patients were divided into two groups based on the diameter of their largest stones. Seventy patients had stones larger than 5 mm but less than 15 mm, whereas 50 patients had stones that measured 5 mm or less. The patients were randomly assigned to treatment with chenodeoxycholic acid plus ursodeoxycholic acid (5 mm/kg of each) or ursodeoxycholic acid (10 mm/kg) alone. Oral cholecystography, plain abdominal x-rays, and ultrasonography of the gallbladder were done at 6, 12, and 24 months. Dissolution was deemed to be complete if not stones were visualized on two examinations. partial dissolution was defined as a 50% reduction in stone size and/or number. Stones that were not detected by cholecystography but still detected during ultrasonography were considered to be partially dissolved. Plasma triglycerides, serum cholesterol, HDL, and serologic liver function tests were determined at 1, 3, 6, 12, 18, and 24 months. In a select group of patients, bile-rich duodenal aspirates were aspirated and analyzed for biliary lipid contents. In the group with small stones, defined as less than or equal to 5 mm, complete stone dissolution occurred significantly more often utilizing combination therapy at 6 months (52% vs 24%), and this trend persisted, although no longer significant, at 12 and 24 months. Combination therapy also achieved an improved rate of dissolution for large stones within 6 months; however, this did not persist at 12 and 24 months. Although not statistically significant, stone calcification occurred less often with combined therapy. All treatment regimens were well tolerated, with only minor changes in bowel habits and mild elevations in serum transaminase levels. Serum lipid levels did not change with either therapy. The authors concluded that the combination of chenodeoxycholic acid and ursodeoxycholic acid was the preferred therapy for gallstone dissolution, because it dissolves stones more rapidly, with a lower incidence of stone calcifications, and thus might reduce the long-term cost of treatment.

Chenodeoxycholic Acid↗

PubMedDate not supplied

[Fasciola hepatica in the common bile duct. Presentation of a case].

A case of hepatic fascioliasis in the common bile duct is reported in a 54 years female. Upon surgical exploration of the biliary tract, one adult form of hepatic Fasciola was found, without evidence of cholelithiasis. Retrospectively we reviewed the oral cholecystography and the image originally believed to be gallstone, in fact was a hepatic Fasciola. Reviewing past literature, we have not encountered any previous case in which hepatic Fasciola was diagnosed by oral cholecystography.

Common Bile Duct Diseases↗

PubMed1988

[Ultrasonics in the diagnosis of hyperplastic cholecystoses of focal and segmental extension type].

The authors describe the sonographic (US) patterns of hyperplastic cholecystoses observed from January 1983 to April 1987 - 39 cases of focal extension and 12 of segmental extension--and confirm the higher sensibility of US versus oral cholecystography. Sonography (SG) allows a straight visualization of the gallbladder wall and its lesions, both in case of limited thickening of the wall (focal cholecystosis) and in case of more extensive thickening (segmental cholecystosis). To cholecystographic findings of focal lesions, SG gives additional information, adding a fundamental diagnostic element: the lack of acoustic shadowing distal to the nodular masses. Nonetheless, SG does not allow a discrimination between focal cholesterolosis and adenomyomatosis, except for particular cases, such as multiple nodular masses, and coexistence with the "comet tail" pattern--the latter due to parietal deposits of cholesterol. Furthermore, the differential diagnosis of focal cholecystoses includes some neoplasms of the gallbladder, and gallstones stuck to the wall, with no acoustic shadowing. In segmental cholecystoses, the direct evaluation of the entity and extension of the wall thickening remains a fundamental diagnostic element, even though such a morphologic detail is often integrated by the functional relieve of hypercontractility of the gallbladder wall after a fatty meal (both oral cholecystography and SG demonstrate it).

Diagnosis, Differential↗

PubMed1978

[Diagnostic value of retrograde cholangiopancreatography by transendoscopic route].

Endoscopic retrograde cholangiopancreatography (ERCP) is essential in the diagnosis of pancreatic disease, jaundice and in post-cholecystectomy syndromes, as well as in cases where cholecystography and i.v. cholangiography fail to explain disturbances that strongly suggest bile duct involvement. Its confirmation of clinically established pancreatic disease is much more positive than that given by scintiscanning and multiple superselective arteriography. Unlike the latter, it also permits the differential diagnosis of chronic pancreatitis, cancer of the pancreas, pseudocysts, etc. and distinguishes medical and surgical pancreatitis (stenosis, proteinaceous calculi, and obstructing pseudocysts). Differential diagnosis of progressive jaundice on clinical grounds or with the aid of ordinary means of examination is sometimes unsatisfactory. ERCP clearly distinguishes medical and surgical forms, so that exploratory laparotomy is not needed in subjects with liver-cell forms. It also shows the nature, site and extent of extrahepatic obstruction, and points to the organic cause in 79% of cases of postcholecystectomy syndrome. Right hypochondrial pain or intermittent jaundice and negative cholecystography and i.v. cholangiography is a further indication, since ERCP will reveal disease of the pancreas or bile ducts (cholelithiasis, choledocholithiasis, sclerosing cholangitis, etc). It is also useful in the diagnosis of cirrhosis, abscess, echinococcus cyst and primary or secondary cancer in cases where needle biopsy and-or arteriography are either contra-indicated or inconclusive.

Biliary Tract Diseases↗

PubMedDate not supplied

[The importance of pre-operative ultrasonography in assessing the technical difficulty and potential complications of laparoscopic cholecystectomy].

In this work thirty patients with symphtomatic not complicated gallbladder disease were studied by ultrasound (US) and by oral-cholecystography, to value the correlation between the results and the surgical judgement of laparoscopic cholecystectomy (LC) difficulty level (by Visual Analogue Scale). Wall thickening and diminished gallbladder function were significantly (P < 0.001) associated with increased technical difficulty of LC. Moreover the US evaluation of Veress's needle insertion seat is helpful. There was no significantly association between LC operative difficulty and volume and other US parameters (P > 0.05). Basing on results and on literature review, US and oral-cholecystography can be considered as predictors of LC operative difficulties and it can be used as a screening.

Adult↗